M80.00XA Insurance Policy Changes

ICD-10 M80.00XA is officially defined as "Age-related osteoporosis with current pathological fracture, unspecified site, initial encounter for fracture." code M80.00XA is referenced in 6 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 M80.00XA is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 5, 2026Medium impact
Infrared Therapy (CPB 0604, reviewed 2026-09-09)
Aetna considers infrared coagulation medically necessary for anal dysplasia and for members with grade I, II, or III internal hemorrhoids that are painful or persistently bleeding. Low-level infrared light therapy is considered experimental, investigational, or unproven for a long list of indications, including osteoarthritis, migraines, stroke, and diabetes mellitus, and the infrared glove is unproven for Raynaud's syndrome and all other indications. CPT 46930 is covered when selection criteria are met, while CPT 97026 and HCPCS codes A4639 and E0221 are not covered for the listed indications.
Aetna · Identified Oct 3, 2026Medium impact
Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-10-01)
Aetna's Clinical Policy Bulletin 0954 covers romosozumab-aqqg (Evenity) for commercial medical plans when treating postmenopausal osteoporosis in members with a history of fragility fractures, or with a pre-treatment T-score of -2.5 or lower, or with osteopenia and a high pre-treatment FRAX probability plus one of the listed risk or prior-therapy criteria. Treatment is limited to 12 monthly doses, and monthly injections are considered contraindicated and not medically necessary for members who have had a myocardial infarction or stroke within the preceding year. Glucocorticoid-induced osteoporosis, rheumatoid arthritis, osteoporosis related to maintenance hemodialysis, osteogenesis imperfecta, and several other indications are listed as experimental, investigational, or unproven.
Aetna · Identified Sep 29, 2026Medium impact
Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2026-08-21)
Aetna considers measurements of bone turnover markers for evaluating fracture risk experimental, investigational, or unproven, including bone sialoprotein, cathepsin K, osteocalcin, osteoprotegerin, P1NP, RANKL, sclerostin, and CTX-1 and NTX-1 telopeptides. Aetna also considers plasma homocysteine for evaluating fracture risk, plasma leptin for osteoporosis screening, and serum or urinary collagen crosslinks or other bone remodeling markers for the screening, diagnosis, or management of osteoporosis experimental, investigational, or unproven. Measurement of bone-specific alkaline phosphatase as a diagnostic marker for children and adolescents with secondary osteoporosis, bone turnover markers for persons receiving serotonergic anti-depressants, and collagen crosslinks for bisphosphonate-induced jaw osteonecrosis, chronic kidney disease, or osteogenesis imperfecta are also experimental, investigational, or unproven.
Aetna · Identified Aug 19, 2026Medium impact
Zoledronic Acid (CPB 0524, reviewed 2026-02-12)
Aetna's clinical policy bulletin covers zoledronic acid for commercial medical plans. Zoledronic acid 5 mg (Reclast or generic) is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget's disease of bone, and treatment-related bone loss in men with prostate cancer receiving androgen deprivation therapy, when the listed criteria are met. Zoledronic acid 4 mg (formerly branded Zometa) is considered medically necessary for bone metastases from a solid tumor, certain breast cancer indications, hypercalcemia of malignancy, Langerhans cell histiocytosis with bone disease, multiple myeloma, and systemic mastocytosis with osteopenia or osteoporosis. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-02-20)
For commercial plans, Aetna considers romosozumab-aqqg (Evenity) medically necessary for postmenopausal osteoporosis when a member has a history of fragility fractures, or a pre-treatment T-score less than or equal to -2.5, or osteopenia with a high pre-treatment FRAX probability plus very high fracture risk indicators, an inadequate response or intolerance to previous injectable osteoporosis therapy, or an inadequate response or intolerance to oral bisphosphonate therapy. Continuation is medically necessary for members who meet all initial selection criteria and have received less than 12 monthly doses. Aetna considers it contraindicated and not medically necessary for members who have had a myocardial infarction or stroke within the preceding year, and experimental, investigational or unproven for glucocorticoid-induced osteoporosis, rheumatoid arthritis, and several other listed indications.
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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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code M80.00XA?

There are 6 tracked policy changes affecting code M80.00XA, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code M80.00XA?

Payers that have issued tracked updates for code M80.00XA include: Aetna.

How do I get notified when code M80.00XA policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M80.00XA. 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 M80.00XA?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Infrared Therapy (CPB 0604, reviewed 2026-09-09)

Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-10-01)

Biochemical Markers of Bone Remodeling (CPB 0562, reviewed 2026-08-21)

Zoledronic Acid (CPB 0524, reviewed 2026-02-12)

Romosozumab-aqqg (Evenity) (CPB 0954, reviewed 2026-02-20)

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

What insurance policy changes affect code M80.00XA?

Which payers have updated policy for code M80.00XA?

How do I get notified when code M80.00XA policy changes?

Why do payers change policies for code M80.00XA?