C07 Insurance Policy Changes

ICD-10 C07 is officially defined as "Malignant neoplasm of parotid gland." code C07 is referenced in 7 tracked payer policy changes from Blue Cross Blue Shield of North Dakota and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C07 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross Blue Shield of North Dakota · Effective Sep 9, 2026Medium impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota updated its commercial pharmacy policies, and the revisions to the commercial prior authorization medical drug policies are effective September 9, 2026. Revisions to the commercial post service claim edit medical drug policies are effective August 1, 2026. Many of the prior authorization policies now state the number of days allowed for initial and renewal authorization durations, replace specific contraindications in the Universal Criteria with general language that the member does not have any FDA contraindications, and add covered ICD-10 diagnosis codes in Appendix 1.
Aetna · Identified Oct 18, 2026Medium impact
Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-10-14)
Aetna considers gonadotropin-releasing hormone (GnRH) analogs and antagonists medically necessary for commercial plan members only for the specific indications listed for each drug, including leuprolide, goserelin, histrelin, triptorelin, degarelix, cetrorelix and ganirelix, and treats all other indications as experimental, investigational or unproven. Each drug has separate criteria for initial approval and for continuation of therapy, and continuation for prostate cancer requires clinical benefit such as serum testosterone less than 50 ng/dL and no unacceptable toxicity. Precertification is required for the prostate cancer indication, and gender dysphoria treatment for members under 18 must be prescribed by or in consultation with a provider specialized in the care of transgender youth who has collaborated care with a mental health provider.
Aetna · Identified Aug 18, 2026Medium impact
Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)
Aetna considers temsirolimus (Torisel or generic temsirolimus) medically necessary as a single agent for subsequent treatment of locally advanced, recurrent, or metastatic endometrial carcinoma, for relapsed or refractory mantle cell lymphoma, and for advanced renal cell carcinoma. It also considers it medically necessary for specified soft tissue sarcoma subtypes, for rhabdomyosarcoma (maximum 12 cycles, with cyclophosphamide and vinorelbine), and for subsequent treatment of advanced, recurrent/metastatic, or inoperable PEComa in uterine sarcoma. Aetna considers all other indications experimental, investigational, or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
Aetna · Identified Aug 17, 2026Medium impact
Ado-trastuzumab Emtansine (Kadcyla) (CPB 0974, reviewed 2026-01-21)
Aetna covers ado-trastuzumab emtansine (Kadcyla) for commercial medical plans and requires precertification for it. Covered uses include HER2-positive breast cancer in the settings listed in the policy, non-small cell lung cancer with HER2 (ERBB2) mutations when the drug is used as a single agent and the member has not progressed on a HER2 targeted drug such as Enhertu, and recurrent, unresectable or metastatic HER2-positive salivary gland tumors. Aetna considers all other indications experimental, investigational, or unproven, including use together with Herceptin, Tykerb or Perjeta, HER2-negative breast cancer, gastric cancer, colorectal cancer and hepatobiliary cancers.
Aetna · Identified Aug 15, 2026Medium impact
Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-07-10)
Aetna covers gonadotropin-releasing hormone (GnRH) analogs and antagonists under its commercial medical plans for the indications the policy lists, including prostate cancer, breast cancer, ovarian cancer, central precocious puberty, endometriosis, uterine leiomyomata (fibroids), and ovulation induction or assisted reproductive technology. The policy also sets criteria for gender dysphoria treatment, including pubertal suppression in adolescents and gender transition, and for continuation of therapy. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)
Carbogen inhalation therapy (5% carbon dioxide and 95% oxygen) is considered experimental, investigational, or unproven for bladder cancer, central retinal artery occlusion, cervical cancer, fracture healing, head and neck cancers, optic nerve damage or degeneration, prostate cancer, retinal artery occlusion, seizures, stroke, and sudden hearing loss. The policy lists no specific CPT or HCPCS code for carbogen inhalation therapy, and the ICD-10 diagnosis codes for these indications are listed as not covered for carbogen inhalation therapy. The policy was last reviewed 07/09/2026.
Aetna · Identified Aug 13, 2026Medium impact
Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)
Aetna considers albumin-bound paclitaxel (Abraxane or generic albumin-bound paclitaxel) medically necessary for the cancers listed in its initial approval criteria, including Kaposi sarcoma, breast cancer, cutaneous melanoma, endometrial carcinoma, ovarian, fallopian tube and primary peritoneal cancer, biliary tract cancers, non-small cell lung cancer, pancreatic adenocarcinoma, small bowel adenocarcinoma, uveal melanoma, ampullary adenocarcinoma, cervical cancer, bladder cancer and vaginal cancer, when each cancer's stated criteria are met. All other indications are considered experimental, investigational, or unproven, including small cell lung cancer, prostate cancer, soft-tissue sarcoma and gastric cancer. Continuation of therapy is medically necessary for an approved indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C07?

There are 7 tracked policy changes affecting code C07, including updates from Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C07?

Payers that have issued tracked updates for code C07 include: Blue Cross Blue Shield of North Dakota, Aetna.

How do I get notified when code C07 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C07. 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 C07?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Pharmacy Policies Available Online

Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-10-14)

Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)

Ado-trastuzumab Emtansine (Kadcyla) (CPB 0974, reviewed 2026-01-21)

Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-07-10)

Carbogen Inhalation Therapy (CPB 0428, reviewed 2026-07-09)

Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)

What insurance policy changes affect code C07?

Which payers have updated policy for code C07?

How do I get notified when code C07 policy changes?

Why do payers change policies for code C07?