What insurance policy changes affect CPT 96368?

There are 25 tracked policy changes affecting CPT 96368, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 96368?

Payers that have issued tracked updates for CPT 96368 include: Aetna.

How do I get notified when CPT 96368 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 96368. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 96368?

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.

96368 — An IV infusion given at the same time as another treatment or diagnostic procedure to support your care.: Insurance Policy Changes

96368 Insurance Policy Changes

CPT 96368, in plain terms, covers An IV infusion given at the same time as another treatment or diagnostic procedure to support your care. CPT 96368 is referenced in 25 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for CPT 96368 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Fidanacogene Elaparvovec-dzkt (Beqvez) (CPB 1060, reviewed 2026-04-20)

Aetna·Effective Apr 20, 2026

Aetna has established a new clinical policy (CPB 1060, effective 2026-04-20) for fidanacogene elaparvovec-dzkt (Beqvez), a gene therapy for hemophilia B. This one-time intravenous infusion requires mandatory precertification, must be administered at Aetna Institutes GCIT Network facilities, and has strict patient selection criteria including age ≥18, no prior Factor IX inhibitors, negative AAVRh74var antibody testing, and documented uncontrolled disease despite prophylactic therapy. Billing teams must implement prior authorization workflows and ensure claims route through designated GCIT network providers.

96368 Insurance Policy Changes

Inebilizumab-cdon (Uplizna) (CPB 0975, reviewed 2026-08-11)

Efgartigimod Alfa-fcab (Vyvgart) and Efgartigimod Alfa and Hyaluronidase-qvfc (Vyvgart Hytrulo) (CPB 1002, reviewed 2026-08-11)

Mirikizumab-mrkz (Omvoh) (CPB 1048, reviewed 2026-07-01)

Anifrolumab-fnia (Saphnelo) (CPB 0997, reviewed 2026-06-05)

Valoctocogene Roxaparvovec-rvox (Roctavian) (CPB 1037, reviewed 2026-04-20)

Fidanacogene Elaparvovec-dzkt (Beqvez) (CPB 1060, reviewed 2026-04-20)

Carfilzomib (Kyprolis) (CPB 0845, reviewed 2026-03-02)

Remdesivir (Veklury) (CPB 0982, reviewed 2026-01-13)

Ketamine for the Treatment of Depression and Other Selected Indications (CPB 0938, reviewed 2025-12-30)

Panitumumab (Vectibix) (CPB 0748, reviewed 2025-12-23)

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

Natalizumab (CPB 0751, reviewed 2025-12-02)

Nesiritide (Natrecor) (CPB 0709, reviewed 2025-11-24)

Tebentafusp-tebn (Kimmtrak) (CPB 1005, reviewed 2026-04-09)

Elivaldogene Autotemcel (Skysona) (CPB 1017, reviewed 2026-04-08)

Spesolimab-sbzo (Spevigo) (CPB 1013, reviewed 2026-04-02)

Narsoplimab-wuug (Yartemlea) (CPB 1099, reviewed 27-2026-04)

Pegzilarginase-nbln (Loargys) (CPB 1101, reviewed 26-2026-06)

Plasminogen, Human-tvmh (Ryplazim) (CPB 0976, reviewed 2026-02-17)

Lovotibeglogene Autotemcel (Lyfgenia) (CPB 1053, reviewed 2025-12-31)

Betibeglogene Autotemcel (Zynteglo) (CPB 1016, reviewed 2025-12-31)

Ibalizumab-uiyk (Trogarzo) (CPB 0936, reviewed 2025-12-30)

Sutimlimab-jome (Enjaymo) (CPB 1006, reviewed 2025-12-03)

Caplacizumab-yhdp (Cablivi) (CPB 0949, reviewed 2025-12-03)

Brexanolone (Zulresso) (CPB 0951, reviewed 2026-02-13)