T45.1X5S Insurance Policy Changes

ICD-10 T45.1X5S is officially defined as "Adverse effect of antineoplastic and immunosuppressive drugs, sequela." code T45.1X5S is referenced in 3 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 T45.1X5S 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 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 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 T45.1X5S?

There are 3 tracked policy changes affecting code T45.1X5S, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code T45.1X5S?

Payers that have issued tracked updates for code T45.1X5S include: Aetna.

How do I get notified when code T45.1X5S policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T45.1X5S. 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 T45.1X5S?

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)

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

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

What insurance policy changes affect code T45.1X5S?

Which payers have updated policy for code T45.1X5S?

How do I get notified when code T45.1X5S policy changes?

Why do payers change policies for code T45.1X5S?