T45.1X5A Insurance Policy Changes

ICD-10 T45.1X5A is officially defined as "Adverse effect of antineoplastic and immunosuppressive drugs, initial encounter." code T45.1X5A is referenced in 5 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 T45.1X5A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Oct 7, 2025Medium impact
Electrical Stimulation for Nausea, Vomiting, Motion Sickness and Other Selected Indications (CPB 0676, reviewed 2025-10-07)
Aetna updated its policy on transcutaneous electrical acupoint stimulation (TEAS) devices, establishing that prescription ReliefBand and PrimaBella are NOW COVERED for post-operative nausea, chemotherapy-induced nausea unresponsive to antiemetics, and hyperemesis gravidarum unresponsive to conservative therapy. Over-the-counter ReliefBand for motion sickness remains non-covered. Extensive list of other TEAS indications are classified as experimental/investigational and not covered.
Aetna · Identified Aug 19, 2026Medium impact
Vedolizumab (Entyvio) (CPB 0885, reviewed 2026-06-30)
Aetna Clinical Policy Bulletin 0885 covers vedolizumab (Entyvio) for commercial medical plans, requires precertification of all Aetna participating providers and members in applicable plan designs, and refers Medicare criteria to the Medicare Part B Criteria. Vedolizumab is considered medically necessary for moderately to severely active Crohn's disease and ulcerative colitis, and for immune checkpoint inhibitor-related toxicity, acute graft versus host disease and CAR T-cell-related toxicity when the listed criteria are met, and it must be prescribed by or in consultation with a gastroenterologist (or a gastroenterologist, hematologist or oncologist for the non-IBD indications). Continuation is considered medically necessary for members who achieve or maintain remission or a positive clinical response, vedolizumab must not be used concomitantly with another biologic or targeted synthetic drug for the same indication, and collagenous colitis, primary sclerosing cholangitis, spondyloarthritis and serum level testing of vedolizumab and antibodies to vedolizumab are considered experimental, investigational or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Siltuximab (Sylvant) (CPB 0884, reviewed 2026-06-03)
Aetna covers siltuximab (Sylvant) for commercial medical plans when it is used for multicentric Castleman's disease that is HIV-1 negative and HHV-8 negative, for relapsed, refractory or progressive unresectable unicentric Castleman's disease that is HIV-1 negative and HHV-8 negative, and for specific cytokine release syndrome cases, including grade 4 CAR T-cell-induced cytokine release syndrome that is refractory to high-dose corticosteroids and anti-IL-6 therapy. Continuation of therapy is covered when there is no evidence of unacceptable toxicity or disease progression while on the current regimen. Aetna considers all other indications experimental, investigational, or unproven, including breast cancer, multiple myeloma, rheumatoid arthritis and COVID-19.
Aetna · Identified Aug 16, 2026Medium impact
Levoleucovorin (Khapzory) (CPB 0889, reviewed 2025-12-04)
Aetna Clinical Policy Bulletin 0889 covers levoleucovorin (Khapzory) for commercial medical plans, and Medicare criteria are in a separate document. Aetna considers Khapzory more costly than other levoleucovorin products and considers it medically necessary only for members with a contraindication, intolerance or ineffective response to the generic levoleucovorin equivalents, when leucovorin is not an available or appropriate option. Generic or Khapzory levoleucovorin is considered medically necessary for rescue treatment after high-dose methotrexate therapy, treatment of a folate antagonist overdose or impaired methotrexate elimination, or combination therapy with fluorouracil-based chemotherapy regimens, under the same leucovorin condition. Continuation of therapy is considered medically necessary for all members, including new members, who meet the initial criteria. The brand Fusilev has been discontinued by the manufacturer.
Aetna · Identified Aug 12, 2026Medium impact
Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)
Aetna considers certolizumab pegol (Cimzia) medically necessary for commercial medical plans only for members who have a contraindication, intolerance or ineffective response to the listed lower cost targeted immune modulators, with waived trial requirements for members who are pregnant or breastfeeding. Precertification is required of all Aetna participating providers and members in applicable plan designs, and the medication must be prescribed by or in consultation with a specialist such as a rheumatologist, gastroenterologist, dermatologist or oncologist depending on the indication. Aetna considers Cimzia experimental, investigational or unproven for concomitant use with other biologics or targeted synthetic drugs for the same indication and for Behcet's disease, microscopic colitis, ocular inflammation/uveitis, sarcoidosis and severe asthma.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T45.1X5A?

There are 5 tracked policy changes affecting code T45.1X5A, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T45.1X5A?

Payers that have issued tracked updates for code T45.1X5A include: Aetna.

How do I get notified when code T45.1X5A policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T45.1X5A. 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 T45.1X5A?

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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Electrical Stimulation for Nausea, Vomiting, Motion Sickness and Other Selected Indications (CPB 0676, reviewed 2025-10-07)

Vedolizumab (Entyvio) (CPB 0885, reviewed 2026-06-30)

Siltuximab (Sylvant) (CPB 0884, reviewed 2026-06-03)

Levoleucovorin (Khapzory) (CPB 0889, reviewed 2025-12-04)

Certolizumab Pegol (Cimzia) (CPB 0761, reviewed 2026-07-01)

What insurance policy changes affect code T45.1X5A?

Which payers have updated policy for code T45.1X5A?

How do I get notified when code T45.1X5A policy changes?

Why do payers change policies for code T45.1X5A?