What insurance policy changes affect code M75.00?

There are 7 tracked policy changes affecting code M75.00, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code M75.00?

Payers that have issued tracked updates for code M75.00 include: Aetna.

How do I get notified when code M75.00 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M75.00. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for code M75.00?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

PAYER POLICY CHANGES

M75.00 Insurance Policy Changes

ICD-10 M75.00 is officially defined as "Adhesive capsulitis of unspecified shoulder." code M75.00 is referenced in 7 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M75.00 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 26, 2026Medium impact
Pulsed Radiofrequency (CPB 0735, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0735 considers pulsed radiofrequency experimental, investigational, or unproven for all indications in its list, because its effectiveness has not been established. The list includes indications such as carpal tunnel syndrome, chronic knee pain, low back pain, trigeminal neuralgia, and headache. The policy also considers the Stimpod NMS460 nerve stimulator for post-amputation pain, combined ganglion impar block and pulsed radiofrequency for pudendal neuralgia, and combined platelet-rich plasma to the Gasserian ganglion and pulsed radiofrequency for trigeminal neuralgia experimental, investigational, or unproven.
Aetna · Identified Oct 10, 2026Medium impact
Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)
Aetna considers repository corticotropin injection (Acthar Gel only) medically necessary for infantile spasms in members less than 2 years of age, and considers all other indications experimental, investigational, unproven, or not medically necessary. Precertification of Acthar Gel or Purified Cortrophin Gel is required of all Aetna participating providers and members in applicable plan designs. Purified Cortrophin Gel is considered experimental, investigational, or unproven for infantile spasms because it is not FDA-approved, nor has a compendial use, for this indication, and use of Acthar Gel in combination with Purified Cortrophin Gel is considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Nerve Blocks (CPB 0863, reviewed 2026-07-23)
Aetna Clinical Policy Bulletin 0863 covers nerve blocks and lists which ones it considers medically necessary. Covered uses include adductor canal, femoral, fascia iliaca, erector spinae plane and transversus abdominis plane blocks for post-operative pain after specific surgeries, and celiac plexus block for cancer pain, while peripheral nerve blocks for chronic pain are covered only as an active component of a comprehensive pain management program. Blocks listed as experimental and investigational include genicular nerve blocks and peripheral nerve blocks used as the sole treatment for chronic non-malignant pain, because the effectiveness of these approaches has not been established.
Aetna · Identified Aug 18, 2026Medium impact
Manipulation Under General Anesthesia (CPB 0204, reviewed 2026-03-25)
Aetna considers manipulation under anesthesia (MUA) medically necessary for arthrofibrosis of the knee following total knee arthroplasty, knee surgery, or fracture, for chronic refractory frozen shoulder (adhesive capsulitis), and for temporomandibular joint disorders. Spinal manipulation under general MUA is considered experimental, investigational, or unproven, and CPT 22505 is not covered for the indications listed in the policy. The policy does not apply to examinations under anesthesia, or to setting fractures or complete joint dislocations under anesthesia.
Aetna · Identified Aug 14, 2026Medium impact
Electrothermal Arthroscopy (CPB 0545, reviewed 2026-07-31)
Aetna considers electrothermal arthroscopy, also called electrothermally-assisted capsule shift or capsulorrhaphy (ETAC), of the joint capsule, ligaments, or tendons experimental, investigational, or unproven for all indications. The listed indications include shoulder instability, Bankart lesions, frozen shoulder, ligament tears and meniscal injury of the knee, partial scapholunate ligament tears, temporomandibular joint dislocation, and wrist injuries. HCPCS S2300 (arthroscopy, shoulder, with thermally-induced capsulorrhaphy) is listed as not covered for the indications in the policy.
Aetna · Identified Aug 13, 2026Medium impact
Phonophoresis (CPB 0210, reviewed 2026-03-27)
Aetna considers phonophoresis experimental, investigational, or unproven for all indications, including adhesive capsulitis, carpal tunnel syndrome, knee osteoarthritis, low back pain, neck pain, sinusitis, chronic obstructive pulmonary disease, and venous and diabetic ulcers, because its effectiveness has not been established. Controlled clinical trials have failed to demonstrate that phonophoresis increases the rate or extent of absorption of analgesics and anti-inflammatory agents. Bee venom phonophoresis and Contractubex phonophoresis are listed as not covered for the indications in the policy.
Aetna · Identified Aug 15, 2026Low impact
Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2025-10-02)
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.

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Pulsed Radiofrequency (CPB 0735, reviewed 2026-10-21)

Repository Corticotropin Injection (Acthar Gel and Purified Cortrophin Gel) (CPB 0762, reviewed 2026-10-08)

Nerve Blocks (CPB 0863, reviewed 2026-07-23)

Manipulation Under General Anesthesia (CPB 0204, reviewed 2026-03-25)

Electrothermal Arthroscopy (CPB 0545, reviewed 2026-07-31)

Phonophoresis (CPB 0210, reviewed 2026-03-27)

Extracorporeal Shock-Wave Therapy for Musculoskeletal Indications and Soft Tissue Injuries (CPB 0649, reviewed 2025-10-02)

What insurance policy changes affect code M75.00?

Which payers have updated policy for code M75.00?

How do I get notified when code M75.00 policy changes?

Why do payers change policies for code M75.00?