ICD-10 M50.00 is officially defined as "Cervical disc disorder with myelopathy, unspecified cervical region." code M50.00 is referenced in 11 tracked payer policy changes from Health Net, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M50.00 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
CalViva Health updated multiple medical policies for Q1 2020, affecting prior authorization requirements, coverage criteria, and billing codes across numerous specialties. Key changes include new coronavirus testing guidelines, updated DME criteria, revised surgical procedure coverage, and modified prior authorization requirements for various treatments.
Health Net updated multiple medical policies in Q1 2020, including new prior authorization requirements, coverage changes for various procedures, and updated billing codes. Key changes include new coronavirus testing guidelines, revised DME criteria, and updated coverage for procedures like facet joint injections and nerve blocks.
Health Net updated multiple medical policies for Q1 2020, including new COVID-19 testing guidelines, changes to prior authorization requirements for various procedures, and updates to coverage criteria for DME, nerve blocks, transplants, and other services. Most notably, several procedures were reclassified as not medically necessary or investigational, affecting billing and coverage.
Aetna Clinical Policy Bulletin 0602 considers thermal intradiscal procedures experimental, investigational, or unproven for relief of discogenic pain or other indications because their effectiveness has not been established. The named thermal procedures include IDET, Nucleoplasty, percutaneous intradiscal radiofrequency thermocoagulation (PIRFT), intradiscal biacuplasty and targeted disc decompression. The bulletin also lists glucocorticoid, platelet-rich plasma, bone marrow, stem cell, methylene blue, condoliase and collagenase intradiscal injections as experimental, investigational, or unproven, and states that CMS has issued a national non-coverage determination for TIPs.
Aetna Clinical Policy Bulletin 0112, last reviewed 03/25/2026, considers high-density surface EMG, surface scanning EMG, paraspinal surface EMG and macro EMG experimental, investigational, or unproven as a diagnostic test for low back pain and other thoracolumbar segmental abnormalities, and for all other indications. It also considers surface EMG devices for diagnosis and/or monitoring of nocturnal bruxism experimental, and lists the Neurophysiologic Pain Profile (NPP), the spine matrix (lumbar matrix) scan and Spinoscopy under the same experimental designation. The bulletin states that surface scanning EMG should not be confused with conventional needle EMG or with surface electrodes used in EMG biofeedback, which it considers medically necessary for appropriate indications.
Aetna considers thermal intradiscal procedures (TIPs) experimental, investigational, or unproven for relief of discogenic pain or other indications because their effectiveness has not been established. Intradiscal electrothermal therapy (IDET) is considered experimental and investigational and is not covered because of the lack of prospective randomized controlled clinical trials with adequate follow up demonstrating its effectiveness. The policy also lists other intradiscal procedures Aetna considers experimental, investigational, or unproven, including intradiscal glucocorticoid injection for low back pain, intradiscal injection of platelet-rich plasma for discogenic low back pain, and intradiscal injection of condoliase for lumbar disc herniation. The CPT codes 22526, 22527 and 62287 are listed as not covered for the indications in the policy, as are the HCPCS codes G0460, P9020, S2142, S2150 and S2348.
Aetna considers diagnostic selective transforaminal epidural steroid injections (TFESIs) with imaging guidance medically necessary for chronic radiculopathy when the diagnosis remains uncertain after standard evaluation, and considers an initial therapeutic TFESI medically necessary when physical therapy and non-narcotic analgesics have failed or become intolerant and the radicular pain is consistent with radiologic findings. Additional therapeutic TFESIs are medically necessary when the initial injection produced at least two of the following for at least 2 weeks: 50% or greater pain relief, increased level of function or physical activity, or reduced pain medication use and/or additional medical care such as physical therapy or chiropractic care. A maximum of twelve TFESIs per spinal region is considered medically necessary, administered during a maximum of three sessions for an episode of pain lasting six months, and TFESI sessions more frequent than every two weeks are considered not medically necessary.
Quantitative sensory testing (QST), current perception threshold (CPT) testing, voltage-actuated sensory nerve conduction threshold (VsNCT) testing, and quantitative thermal testing for early diagnosis of leprosy are considered experimental, investigational, or unproven for the uses listed in this policy, because their effectiveness or clinical value has not been established. Listed uses include evaluating fibromyalgia pain, chronic itch, chronic pelvic pain, and shoulder pain, and diagnosing restless legs syndrome and small fiber neuropathy in postural orthostatic tachycardia syndrome. CPT codes 0106T through 0110T and HCPCS code G0255 are not covered for the listed indications.
Aetna considers MRI medically necessary for appropriate indications without regard to the field strength or configuration of the MRI unit. Aetna considers intermediate and low field strength MRI units, and open MRI units of any configuration including units that allow imaging when standing (Stand-Up MRI) or sitting, to be acceptable alternatives to standard closed MRI units. Aetna considers repeat MRI scans in different positions (such as flexion, extension, rotation and lateral bending) and when done with and without weight-bearing to be experimental, investigational, or unproven for all indications because of insufficient evidence of this approach.
This is Aetna Clinical Policy Bulletin 0649, reviewed October 2, 2025 and first found by PolicyChanges in August 2026, so it is historical material and the current version should be confirmed before acting. Aetna covers extracorporeal shock-wave therapy only for calcific tendinopathy of the shoulder with a calcium deposit of at least 1 cm lasting 6 months or more after conservative care has failed, and lists dozens of other musculoskeletal, wound and medical uses as experimental, investigational or unproven.
Independence Administrators has reissued policy 11.14.29h (now superseded by 11.14.29i as of 04/30/2025) for spinal discectomy with no substantive coverage changes. The policy continues to cover lumbar and cervical discectomy procedures meeting documented criteria (radiculopathy/myelopathy, failed conservative treatment, imaging confirmation). Annulus repair devices (Xclose, Barricaid, DART, Inclose) remain classified as experimental/investigational and are not covered. This is a routine annual policy reissuance with continued position communication.
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