What insurance policy changes affect code Z87.312?

There are 2 tracked policy changes affecting code Z87.312, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code Z87.312?

Payers that have issued tracked updates for code Z87.312 include: Aetna.

How do I get notified when code Z87.312 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code Z87.312. 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 Z87.312?

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

Z87.312 Insurance Policy Changes

ICD-10 Z87.312 is officially defined as "Personal history of (healed) stress fracture." code Z87.312 is referenced in 2 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 Z87.312 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

Aetna · Identified Sep 30, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-08-21)
Aetna covers Prolia and its ten listed biosimilars, and Xgeva and its nine listed biosimilars, under commercial medical plans, and precertification is required for these denosumab products in applicable plan designs. Prolia is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis, based on criteria such as fragility fracture history, pre-treatment T-score, pre-treatment FRAX probability, and prior therapy response or intolerance. Xgeva is considered medically necessary for multiple myeloma, bone metastases from solid tumors, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis, and continuation of Xgeva requires disease stability or improvement.
Aetna · Identified Aug 13, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-06-08)
Aetna's commercial medical policy sets coverage criteria for Prolia and its biosimilars and for Xgeva and its biosimilars, and precertification is required for these products in applicable plan designs. Prolia and its biosimilars are considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis. Xgeva and its biosimilars are considered medically necessary for multiple myeloma, bone metastases from a solid tumor, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis. All other indications are considered experimental, investigational, or unproven, and combination therapy of denosumab with intravenous bisphosphonates is also considered experimental, investigational, or unproven.

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Denosumab (CPB 0804, reviewed 2026-08-21)

Denosumab (CPB 0804, reviewed 2026-06-08)

What insurance policy changes affect code Z87.312?

Which payers have updated policy for code Z87.312?

How do I get notified when code Z87.312 policy changes?

Why do payers change policies for code Z87.312?