M90.551 Insurance Policy Changes

ICD-10 M90.551 is officially defined as "Osteonecrosis in diseases classified elsewhere, right thigh." code M90.551 is referenced in 6 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 M90.551 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 Oct 25, 2026Medium impact
Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0753 on core decompression for avascular necrosis lists a last review date of 10/21/2026, but the text does not describe what changed. Aetna considers core decompression medically necessary for early or pre-collapse (stage I or II) avascular necrosis of the hip, and considers it experimental, investigational or unproven for late or post-collapse (stage III or higher) hip avascular necrosis and for avascular necrosis of other joints. Aetna also considers several adjunctive treatments experimental, investigational or unproven for avascular necrosis of any joint, including bone marrow concentrate, platelet-rich plasma, bisphosphonates, bone morphogenic proteins and synthetic bone graft substitutes.
Aetna · Identified Oct 11, 2026Medium impact
Joint Resurfacing (CPB 0661, reviewed 2026-10-07)
Metal-on-metal hip resurfacing with an FDA-approved device is considered medically necessary as an alternative to total hip arthroplasty for physically active members under 65 who have advanced hip joint disease from osteoarthritis, avascular necrosis or post-traumatic arthritis and meet the listed criteria. Members should have at least 12 weeks of documented non-surgical treatment, unless contraindicated. Hip resurfacing is considered not medically necessary with contraindications such as active joint infection, metal allergy, morbid obesity (BMI greater than 40) and females of child-bearing age, and shoulder, knee, patellar, wrist, facet joint, toe joint and other listed resurfacing procedures are considered experimental, investigational or unproven.
Aetna · Identified Oct 4, 2026Medium impact
Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation (CPB 0599, reviewed 2026-09-18)
Autologous skeletal myoblast transplantation, intra-coronary and intra-myocardial autologous bone marrow cell transplantation, and intra-arterial or intra-muscular autologous mononuclear bone marrow cell transplantation are considered experimental, investigational, or unproven because effectiveness has not been established. Autologous or allogeneic bone marrow-derived mesenchymal stem cell transplantation is likewise considered experimental, investigational, or unproven for conditions including acute myocardial infarction, diabetes, multiple sclerosis, knee osteoarthritis, spinal cord injury, rheumatoid arthritis, Crohn's disease, and peripheral nerve repair. CPT codes 0263T, 0264T, 0265T, 38240, and 38241 and HCPCS code C9782 are listed as not covered for the listed indications, and the ICD-10 codes for those indications are listed as not covered for these services.
Aetna · Identified Aug 16, 2026Medium impact
Joint Resurfacing (CPB 0661, reviewed 2025-12-19)
Aetna considers metal-on-metal hip resurfacing with an FDA-approved device a medically necessary alternative to total hip arthroplasty for physically active non-elderly adult members under 65 who meet the listed criteria, and experimental, investigational, or unproven for all other indications. The policy also lists shoulder resurfacing, knee, partial knee and patellar resurfacing, wrist capitate resurfacing, metatarsophalangeal joint resurfacing, facet joint resurfacing, talar inlay resurfacing and navigation during hip resurfacing as experimental, investigational, or unproven. The policy history shows an original effective date of 05/02/2003 and a last review date of 10/07/2026.
Aetna · Identified Aug 15, 2026Medium impact
Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2025-10-30)
Aetna considers core decompression medically necessary for early or pre-collapse avascular necrosis of the hip, meaning stage I or II before X-ray changes are evident, and the presence of cysts is considered stage II under the Ficat classification. Core decompression is experimental, investigational or unproven for late or post-collapse hip disease (stage III or higher, when X-ray changes have occurred), for avascular necrosis of other joints such as the ankle, elbow, knee, mandibular condyle and shoulder, and for post-arthroscopic osteonecrosis. Adjunctive treatments for avascular necrosis of any joint, including bone morphogenic proteins, growth factors, mesenchymal stem cells, platelet-rich plasma, synthetic bone graft substitutes and biological augmentation with retro-drilling core decompression, are also listed as experimental, investigational or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code M90.551?

There are 6 tracked policy changes affecting code M90.551, 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 M90.551?

Payers that have issued tracked updates for code M90.551 include: Excellus BlueCross BlueShield, Aetna.

How do I get notified when code M90.551 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code M90.551. 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 M90.551?

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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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

Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2026-10-21)

Joint Resurfacing (CPB 0661, reviewed 2026-10-07)

Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation (CPB 0599, reviewed 2026-09-18)

Joint Resurfacing (CPB 0661, reviewed 2025-12-19)

Core Decompression for Avascular Necrosis (CPB 0753, reviewed 2025-10-30)

What insurance policy changes affect code M90.551?

Which payers have updated policy for code M90.551?

How do I get notified when code M90.551 policy changes?

Why do payers change policies for code M90.551?