What insurance policy changes affect code M84.759S?

There are 3 tracked policy changes affecting code M84.759S, including updates from Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code M84.759S?

Payers that have issued tracked updates for code M84.759S include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when code M84.759S policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M84.759S. 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 M84.759S?

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

M84.759S Insurance Policy Changes

ICD-10 M84.759S is officially defined as "Complete oblique atypical femoral fracture, unspecified leg, sequela." code M84.759S is referenced in 3 tracked payer policy changes from Excellus BlueCross BlueShield and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code M84.759S is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Jan 1, 2027Medium impact
Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121
Excellus BlueCross BlueShield medical policy 7.01.121 sets the medical necessity criteria for hip joint procedures for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) members. The current effective date is January 1, 2027. The policy covers partial and total hip arthroplasty, hip resurfacing, pediatric pelvic or femoral osteotomy for developmental dysplasia of the hip, hip arthroscopy, and hip labral repair, and it lists indications that are not medically necessary. The policy history shows a 10/22/26 off-cycle review that removed site of care criteria, clarified developmental hip dysplasia and primary cause of surgery, removed imaging requirements for pediatric osteotomy patients, and reformatted age-appropriate clinical findings.
Aetna · Identified Aug 15, 2026Medium impact
Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)
Carbogen inhalation therapy (5% carbon dioxide and 95% oxygen) is considered experimental, investigational, or unproven for bladder cancer, central retinal artery occlusion, cervical cancer, fracture healing, head and neck cancers, optic nerve damage or degeneration, prostate cancer, retinal artery occlusion, seizures, stroke, and sudden hearing loss. The policy lists no specific CPT or HCPCS code for carbogen inhalation therapy, and the ICD-10 diagnosis codes for these indications are listed as not covered for carbogen inhalation therapy. The policy was last reviewed 07/09/2026.
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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Orthopedic Joint Procedures of the Hip for Managed Medicaid (MMC), Health and Recovery Plan (HARP), Child Health Plus (CHP), and Essential Plan (EP) Members - (Effective Date - 2027-01-01) 7.01.121

Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)

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

What insurance policy changes affect code M84.759S?

Which payers have updated policy for code M84.759S?

How do I get notified when code M84.759S policy changes?

Why do payers change policies for code M84.759S?