ICD-10 B97.35 is officially defined as "Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere." code B97.35 is referenced in 12 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code B97.35 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross updated MA08.011i to align with FDA labeling and NCCN guidelines for Erythropoiesis Stimulating Agents (ESAs). The policy revises medical necessity criteria for myelodysplastic syndrome, cancer-related anemia, HIV/AIDS, and pediatric chronic kidney disease, and adds 18 new ICD-10 diagnosis codes effective June 29, 2026.
Independence Blue Cross updated policy 08.00.75r on Erythropoiesis-Stimulating Agents (ESAs) effective June 15, 2026, revising coverage criteria for myelodysplastic syndrome, cancer-related anemia, HIV/AIDS, and pediatric chronic kidney disease based on updated FDA labeling and NCCN guidelines. Multiple ICD-10 diagnosis codes were added to the policy to align with current diagnostic classifications. Billing teams must update systems to recognize these new diagnosis codes when processing ESA claims.
Independence Blue Cross updated MA05.021b to version MA05.021c, clarifying that injectable dermal fillers for cosmetic procedures remain covered ONLY for HIV-associated facial lipodystrophy syndrome (LDS) when specific medical necessity criteria are met. The policy explicitly excludes all other dermal fillers and cosmetic indications, including hyaluronic acid products, collagen, autologous fat transfer, and others. Four new CPT codes (11950-11952, 11954) were added to the policy's billing code list.
Aetna considers immune globulins medically necessary for hepatitis B, cytomegalovirus, Rho-D, rabies, varicella zoster, tetanus, vaccinia, botulism, hepatitis A, measles (rubeola) and rubella exposures or conditions, and considers all other indications experimental, investigational, or unproven. Each product has its own initial criteria, such as hepatitis B immune globulin for members who had contact with an individual diagnosed with hepatitis B virus, Rho-D immune globulin for unsensitized Rh-negative women at 24 to 28 weeks gestation unless the father is known to be Rh-negative, and varicella zoster immune globulin for high-risk individuals with significant exposure to varicella. Continuation of therapy for each product is considered medically necessary for all members, including new members, who meet all initial medical necessity criteria.
Aetna's Clinical Policy Bulletin 1102 addresses marnetegragene autotemcel (Kresladi) for commercial medical plans, and it points to the Medicare Part B criteria for Medicare. Precertification is required of all Aetna participating providers and members in applicable plan designs, through National Medical Excellence at 877-212-8811. Unless the member's health plan has elected not to require it, gene and cellular therapies must be administered at an Aetna Institutes GCIT Network, and Aetna considers the one-time administration medically necessary when all listed LAD-I criteria are met.
Aetna's vaginitis diagnosis policy (CPB 0643), last reviewed 09/25/2026, considers nucleic acid amplification or DNA probe tests for trichomonas, Candida and Gardnerella medically necessary for members with dysuria or symptoms of vaginitis. It also considers BVBlue sialidase testing, PCR tests for bacterial vaginosis and Candida, and pH and amine testing medically necessary for women with symptoms. Trichomonas screening is considered medically necessary for women with listed risk factors, including HIV-positive women, new or multiple partners, history of sexually transmitted diseases, exchange of sex for payment, injection drug use, or high-prevalence settings. Routine screening of asymptomatic women for Candida and Gardnerella, Pap smears for the diagnosis of Candida vulvovaginitis, the uBiome SmartJane screen and the 27-organism vaginal pathogen panel are experimental, investigational or unproven, and screening asymptomatic pregnant women for bacterial vaginosis is experimental and not covered.
Aetna considers HIV drug susceptibility and resistance tests, phenotypic or genotypic, medically necessary during acute new-onset HIV infection, for suboptimal viral load suppression after antiretroviral therapy starts, and for virologic failure during highly active antiretroviral therapy (HAART). Phenotypic and genotypic tests performed at the same time are not medically necessary because the approach is duplicative. HIV tropism testing with phenotypic recombinant virus assays (Trofile) or genotypic HIV V3-loop assays is medically necessary before a CCR5 antagonist such as maraviroc (Selzentry) is started.
Aetna considers hepatitis B screening medically necessary for listed groups, including people on hemodialysis, blood or organ donors, pregnant women, people with HIV, injection drug users, men who have sex with men, and people born in regions with a 2% or higher HBV prevalence. Hepatitis C screening is medically necessary for listed groups, and one-time HCV testing without prior risk assessment is medically necessary for adults aged 18 years and older. Hepatitis D screening is medically necessary for people with HBsAg-positive hepatitis B infection and significant risk factors, while hepatitis E screening in the peri-transplant period is experimental, investigational, or unproven.
Reviewed 2025-12-23, Aetna Clinical Policy Bulletin 0544 covers immune globulin products for post-exposure prophylaxis and treatment, including hepatitis B, cytomegalovirus, Rho(D), rabies, varicella zoster, tetanus, measles, rubella, vaccinia, and botulism immune globulins. For each product the policy lists the indications it considers medically necessary and states that all other indications are experimental, investigational, or unproven. Continuation of therapy is considered medically necessary for all members, including new members, who meet the initial criteria. Immune globulin intramuscular injection (GamaSTAN) requires precertification.
Aetna considers several vaginitis tests medically necessary for women with symptoms of vaginitis, including nucleic acid amplification or DNA probe assays for trichomonas, Candida and Gardnerella for members with dysuria or symptoms of vaginitis, sialidase activity testing such as the BVBlue test, and pH and amine testing of vaginal fluid. Screening for Trichomonas vaginalis is considered medically necessary for women with risk factors such as HIV-positive status, new or multiple partners, a history of sexually transmitted diseases, exchange of sex for payment, injection drug use, or high-prevalence settings such as STD clinics and correctional facilities. A Pap smear for the diagnosis of Candida vulvo-vaginitis, routine screening for Candida and Gardnerella in asymptomatic women, the uBiome SmartJane screen, and the 27-organism vaginal pathogen panel from Bridge Diagnostics are considered experimental, investigational, or unproven because their effectiveness has not been established.
This policy reissue updates ICD-10 diagnosis coding for Injectable Dermal Fillers (MA05.021c) effective 10/01/2025. The code E88.1 (Lipodystrophy, not elsewhere classified) has been deleted and replaced with E88.14 (HIV-associated lipodystrophy) to align with annual ICD-10 code updates. No coverage criteria, billing codes, or medical necessity requirements have changed. Billing teams must update internal coding references to use the new ICD-10 code for HIV-associated lipodystrophy claims.
Independence Blue Cross updated policy MA05.021c for injectable dermal fillers effective 10/01/2025, replacing deleted ICD-10 code E88.1 (Lipodystrophy, not elsewhere classified) with E88.14 (HIV-associated lipodystrophy). The policy was reissued on 04/01/2026 with no substantive changes to coverage criteria. Coverage remains limited to Sculptra® and Radiesse® for HIV-associated facial lipodystrophy when depression is a significant contributor.
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