What insurance policy changes affect code C00?

There are 2 tracked policy changes affecting code C00, including updates from Presbyterian Health Plan, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C00?

Payers that have issued tracked updates for code C00 include: Presbyterian Health Plan, Aetna.

How do I get notified when code C00 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C00. 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 C00?

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

C00 Insurance Policy Changes

code C00 is referenced in 2 tracked payer policy changes from Presbyterian Health Plan and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C00 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.

Presbyterian Health Plan · Effective Mar 3, 2026High impact
2026 March Network Connection
Effective March 3, 2026, prior authorization from Evolent is required before oncology chemotherapeutic drugs, supportive agents, symptom management medications and radiation oncology services are administered, for Presbyterian members of all ages with primary diagnoses in the range C00 to D49.9 or E34.0, E34.01 and E34.09. Presbyterian will stop creating secondary claims for dual coverage members on March 13, 2026, so providers will need to submit both primary and secondary claims. HCA is scheduled to go live with Turquoise Claims on March 23, 2026, and telehealth originating site fee Q3014 may only be billed by the eligible facility where the member is physically located.
Aetna · Identified Aug 17, 2026Medium impact
Temozolomide (Temodar) Injection (CPB 0876, reviewed 2026-06-03)
Aetna's Clinical Policy Bulletin 0876 considers temozolomide (Temodar) injection medically necessary for brain metastases from solid tumors, metastatic or unresectable cutaneous melanoma as single agent subsequent therapy, second-line Ewing sarcoma in combination with irinotecan with or without vincristine, mycosis fungoides or Sezary syndrome with CNS involvement as single agent subsequent therapy, high-risk neuroblastoma in combination with irinotecan, dinutuximab and sargramostim or with irinotecan, naxitamab-gqgk and sargramostim, unresectable or metastatic pheochromocytoma or paraganglioma as single agent first-line therapy, relapsed or primary progressive small cell lung cancer as single agent subsequent therapy, advanced, recurrent, metastatic or inoperable uterine sarcoma as single agent subsequent therapy, and unresectable or metastatic uveal melanoma as a single agent. Aetna considers all other indications experimental, investigational or unproven, including chronic lymphocytic leukemia, diffuse large B-cell lymphoma, metastatic colorectal cancer and pituitary tumors. Continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen.

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2026 March Network Connection

Temozolomide (Temodar) Injection (CPB 0876, reviewed 2026-06-03)

What insurance policy changes affect code C00?

Which payers have updated policy for code C00?

How do I get notified when code C00 policy changes?

Why do payers change policies for code C00?