What insurance policy changes affect CPT 96402?

There are 6 tracked policy changes affecting CPT 96402, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for CPT 96402?

Payers that have issued tracked updates for CPT 96402 include: Aetna.

How do I get notified when CPT 96402 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to CPT 96402. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for CPT 96402?

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.

96402 — You receive an injection under the skin or into muscle of cancer-fighting hormonal medication.: Insurance Policy Changes

96402 Insurance Policy Changes

CPT 96402, in plain terms, covers You receive an injection under the skin or into muscle of cancer-fighting hormonal medication. CPT 96402 is referenced in 6 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 96402 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Irinotecan Liposome Injection (Onivyde) (CPB 0902, reviewed 2026-02-24)

Aetna·Effective Feb 24, 2026

Aetna has updated its coverage policy for Irinotecan Liposome Injection (Onivyde) effective immediately, establishing specific medical necessity criteria for ampullary adenocarcinoma and pancreatic adenocarcinoma treatments. The policy defines approved indications including first-line NALIRIFOX regimens, subsequent therapy scenarios, and dosing requirements, while designating all other uses as experimental/investigational. Billing teams must verify patient diagnoses, treatment lines, prior therapy history, and performance status documentation before processing claims for HCPCS code J9205.

96402 Insurance Policy Changes

Fam-trastuzumab Deruxtecan-nxki (Enhertu) (CPB 0966, reviewed 2026-05-15)

Irinotecan Liposome Injection (Onivyde) (CPB 0902, reviewed 2026-02-24)

Oxaliplatin (CPB 0683, reviewed 2025-12-05)

Tagraxofusp-erzs (Elzonris) (CPB 0947, reviewed 2026-05-28)

Crovalimab-akkz (PiaSky) (CPB 1064, reviewed 2026-03-27)

Ziv-Aflibercept (Zaltrap) (CPB 0842, reviewed 2025-12-09)