What insurance policy changes affect code C16.0?

There are 26 tracked policy changes affecting code C16.0, including updates from Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C16.0?

Payers that have issued tracked updates for code C16.0 include: Independence Blue Cross, Aetna.

How do I get notified when code C16.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C16.0. 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 C16.0?

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

C16.0 Insurance Policy Changes

ICD-10 C16.0 is officially defined as "Malignant neoplasm of cardia." code C16.0 is referenced in 26 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 C16.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Oct 1, 2025High impact
11.03.18, Endoscopic Submucosal Dissection (ESD)
Independence Blue Cross has reissued policy 11.03.18 to establish coverage criteria for Endoscopic Submucosal Dissection (ESD) across four clinical scenarios: esophageal squamous cell carcinoma/dysplasia, early-stage esophageal adenocarcinoma/Barrett esophagus dysplasia, gastric early adenocarcinoma, and colorectal lesions. The policy defines specific lesion characteristics, invasion depth thresholds, and lymph node metastasis documentation requirements that must be met for coverage. Billing teams must now ensure claims include proper documentation of lesion staging and use appropriate HCPCS code C9779 for covered procedures.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
MA11.118, Endoscopic Submucosal Dissection (ESD)
Independence Blue Cross has reissued MA11.118 to communicate coverage criteria for Endoscopic Submucosal Dissection (ESD) procedures across four indication categories: esophageal squamous cell carcinoma/dysplasia, early-stage esophageal adenocarcinoma/Barrett esophagus dysplasia, gastric early adenocarcinoma, and colorectal lesions. The policy establishes specific medical necessity criteria for each indication, including lesion size, differentiation, invasion depth, and lymph node metastasis risk documentation. Billing teams must recognize the HCPCS code C9779 for ESD procedures and CPT unlisted codes (43499, 43999, 45399, 45999) as applicable billing options.
Independence Blue Cross · Effective Oct 1, 2025Medium impact
11.03.18, Endoscopic Submucosal Dissection (ESD)
Independence Blue Cross reissued Policy 11.03.18 to communicate coverage criteria for Endoscopic Submucosal Dissection (ESD) across four indications: esophageal squamous cell carcinoma/dysplasia, early-stage esophageal adenocarcinoma/Barrett esophagus dysplasia, gastric early adenocarcinoma, and colorectal lesions. The policy establishes specific clinical criteria (lesion size, differentiation, invasion depth, metastasis risk) that must be met for coverage, and designates all other ESD uses as experimental/investigational and not covered.
Aetna · Identified Oct 20, 2026Medium impact
Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-10-16)
Amivantamab-vmjw (Rybrevant) and amivantamab and hyaluronidase-lpuj (Rybrevant Faspro) are considered medically necessary for commercial plans for non-small cell lung cancer when the initial approval criteria are met, and continuation of therapy is medically necessary on reauthorization when there is no evidence of unacceptable toxicity or disease progression. Precertification is required of all Aetna participating providers and members in applicable plan designs. Use for gastro-esophageal cancer and all other indications is considered experimental, investigational, or unproven.
Aetna · Identified Oct 15, 2026Medium impact
Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)
Aetna considers avelumab (Bavencio) medically necessary for commercial plan members with Merkel cell carcinoma, renal cell carcinoma in combination with axitinib, urothelial carcinomas, gestational trophoblastic neoplasia, endometrial carcinoma, thymic carcinoma, extranodal NK/T-cell lymphoma, colorectal adenocarcinoma, and small bowel adenocarcinoma when the criteria for each indication are met. Precertification of avelumab is required for all Aetna participating providers and members in applicable plan designs, and members who have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy are not eligible. Aetna considers avelumab experimental, investigational, or unproven for all other indications, including breast cancer, non-small cell lung cancer, ovarian cancer, prostate cancer, and pancreatic cancer.
Aetna · Identified Oct 10, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)
Aetna considers radiofrequency ablation (RFA) medically necessary for indications that include colorectal cancer liver metastases, colorectal cancer lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), malignant lung masses in persons who are not candidates for surgical intervention, solitary hepatocellular carcinoma of 5 cm or less or multinodular early-stage HCC in members who are ineligible for or decline surgical resection or transplantation, renal cell carcinoma up to 4 cm in high-risk surgical candidates or in persons with renal insufficiency or a solitary kidney, and osteoid osteoma in individuals who remain symptomatic despite NSAIDs. Aetna considers RFA experimental, investigational, or unproven for combined RFA with transarterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, combined RFA and vertebral cement augmentation for spinal metastases, endoscopic ultrasound-guided RFA for aldosterone-producing adenomas, and all other indications, including curative treatment of primary or metastatic malignant neoplasms in persons able to tolerate surgical resection, biliary obstructions or strictures, renal cysts, renal angiomyolipomas, Brunner's gland hyperplasia, and unresectable localized recurrent thyroid cancers without distant metastases.
Aetna · Identified Oct 8, 2026Medium impact
Docetaxel (CPB 0956, reviewed 2026-10-05)
For commercial medical plans, docetaxel (Beizray, Docivyx, Taxotere, or generic docetaxel) is considered medically necessary for the listed cancer indications, including breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, head and neck cancer, ovarian cancer, small cell lung cancer, and soft tissue sarcoma. Breast cancer requires the disease-status criteria stated in the policy, and continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. All other indications are considered experimental, investigational, or unproven.
Aetna · Identified Sep 30, 2026Medium impact
Fam-trastuzumab Deruxtecan-nxki (Enhertu) (CPB 0966, reviewed 2026-09-17)
Aetna Clinical Policy Bulletin 0966 covers fam-trastuzumab deruxtecan-nxki (Enhertu) for commercial medical plans, and precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers Enhertu medically necessary for breast cancer, biliary tract cancer, esophageal, gastric or gastroesophageal junction adenocarcinoma, HER2-mutant non-small cell lung cancer, and HER2-positive (IHC 3+ or 2+) solid tumors when the stated criteria are met, and considers it experimental, investigational or unproven for all other indications. Continuation of therapy is considered medically necessary on reauthorization when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
Aetna · Identified Aug 19, 2026Medium impact
YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)
Aetna considers Nd:YAG laser capsulotomy medically necessary after cataract extraction in members with visually significant clouding of the posterior capsule, and considers Nd:YAG laser peripheral iridotomy medically necessary for acute primary angle closure, primary angle-closure glaucoma, plateau iris syndrome, aqueous misdirection, and before intraocular lens insertion into the anterior chamber to avoid post-operative iris bombe or pupil block. Capsulotomy performed within 6 months of cataract surgery is subject to medical necessity review, and it is considered experimental, investigational, or unproven if none of the stated criteria is met. Nd:YAG laser vitreolysis for vitreous floaters, posterior hyaloidotomy for pre-macular hemorrhage, goniopuncture for failed trabeculectomy, and peripheral iridotomy to prevent pigment dispersion glaucoma are considered experimental, investigational, or unproven, as are many non-ophthalmological uses such as basal cell carcinoma, benign prostatic hyperplasia, onychomycosis and snoring.
Aetna · Identified Aug 18, 2026Medium impact
Tremelimumab-actl (Imjudo) (CPB 1019, reviewed 2026-04-27)
Aetna considers tremelimumab-actl (Imjudo) medically necessary for commercial medical plans when it is given with durvalumab (Imfinzi) for hepatocellular carcinoma, non-small cell lung cancer, or esophageal, esophagogastric junction or gastric adenocarcinoma. For hepatocellular carcinoma, a one-time single dose is covered for first-line treatment when the disease is unresectable or extrahepatic/metastatic and the member is ineligible for transplant, or for subsequent treatment when the disease is unresectable or extrahepatic/metastatic and the member has not previously been treated with an anti-CTLA4-based regimen. For non-small cell lung cancer, a total of 5 doses is covered with platinum-based chemotherapy when the tumor is negative for EGFR exon 19 deletion and exon 21 L858R mutations and for ALK, RET and ROS1 rearrangements, and for esophageal, esophagogastric junction or gastric adenocarcinoma, a one-time single dose is covered for neoadjuvant treatment when the tumor is MSI-H or dMMR and the member is medically fit for surgery. Precertification is required of all Aetna participating providers and members in applicable plan designs, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Trastuzumab Products (CPB 0313, reviewed 2026-06-08)
Aetna Clinical Policy Bulletin 0313 sets coverage rules for trastuzumab products for commercial medical plans, including Herceptin and the biosimilars Hercessi, Herzuma, Kanjinti, Ogivri, Ontruzant and Trazimera. Aetna considers these products medically necessary for HER2-positive breast cancer in the adjuvant, neoadjuvant and metastatic settings, for HER2-positive esophageal, gastric, biliary, salivary gland, small bowel, appendiceal and uterine serous cancers, and for HER2-positive, RAS and BRAF wild-type colorectal cancer when the listed criteria are met. Aetna considers all other indications experimental, investigational or unproven, including lung, ovarian, pancreatic, prostate, bladder and melanoma, and considers lapatinib plus trastuzumab and pertuzumab plus trastuzumab for HER2-positive breast cancer experimental, investigational or unproven.
Aetna · Identified Aug 18, 2026Medium impact
Tislelizumab-jsgr (Tevimbra) (CPB 1057, reviewed 2025-12-05)
Aetna Clinical Policy Bulletin 1057 sets the commercial medical coverage criteria for tislelizumab-jsgr (Tevimbra). Aetna considers it medically necessary for several cancers under indication-specific criteria, including subsequent treatment of metastatic anal carcinoma, esophageal and esophagogastric junction cancer, HER2-negative gastric adenocarcinoma, metastatic nasopharyngeal cancer, hepatocellular carcinoma, and histologic (Richter) transformation to diffuse large B-cell lymphoma. It also covers MSI-H, dMMR, or POLE/POLD1 ultra-hypermutated small bowel, colon, appendiceal, and rectal adenocarcinomas under the stated criteria, and considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)
Aetna's Clinical Policy Bulletin 0811 considers autologous or allogeneic hematopoietic stem cell transplant, both ablative and non-myeloablative, experimental, investigational, or unproven for the following adult solid tumors: bile duct (cholangiocarcinoma), breast, central nervous system tumors, cervix, colon, esophagus, fallopian tube, gallbladder, kidney, liver, lung, melanoma, nasopharynx, neuroendocrine tumors, pancreas, paranasal sinus, prostate, rectum, soft tissue sarcomas, stomach, thymus, thyroid, tumors of unknown primary origin, and uterus. Aetna considers autologous hematopoietic stem cell transplant medically necessary in young adults with primitive neuroectodermal tumors, medulloblastoma, and Ewing sarcoma family of tumors when criteria are met in CPB 0496.
Aetna · Identified Aug 17, 2026Medium impact
Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-08-05)
Aetna considers amivantamab-vmjw (Rybrevant) or amivantamab and hyaluronidase-lpuj (Rybrevant Faspro) medically necessary for non-small cell lung cancer (NSCLC) with EGFR exon 19 deletion or exon 21 L858R mutation when used with lazertinib, with carboplatin and pemetrexed after disease progression on osimertinib or lazertinib, or as subsequent treatment as listed in the policy, and for NSCLC with EGFR exon 20 insertion mutation as first-line treatment with carboplatin and pemetrexed for nonsquamous disease or as subsequent single-agent treatment. Aetna considers all other indications, including gastro-esophageal cancer, experimental, investigational, or unproven. Continuation of therapy is considered medically necessary for EGFR-positive NSCLC when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Precertification is required for applicable plan designs.
Aetna · Identified Aug 17, 2026Medium impact
Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)
Aetna considers FDA-cleared carbon isotope (13C or 14C) urea breath testing and stool antigen testing (HpSA) medically necessary for active Helicobacter pylori infection in selected persons, including adults with idiopathic thrombocytopenic purpura, persons before bariatric surgery, persons before starting proton pump inhibitor therapy for dyspepsia, and persons taking long term, low-dose aspirin or initiating chronic NSAID treatment. Nucleic acid amplification for clarithromycin resistance testing is medically necessary for selecting salvage regimens for treatment-experienced individuals with persistent H. pylori infection. H. pylori serology, the AmHPR panel, IL-1B and TNFA gene polymorphism testing, and urea breath or stool antigen testing for other indications such as stroke risk, dementia risk and screening of asymptomatic persons are considered experimental, investigational or unproven.
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 17, 2026Medium impact
Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)
Aetna considers flow cytometry for cell surface markers medically necessary for listed conditions, including abnormal tissue, bone marrow or blood histology suspicious for lymphoma, leukemia or myelodysplastic syndrome, multiple myeloma, paroxysmal nocturnal hemoglobinuria, primary immunodeficiencies, Sezary syndrome diagnosis, and T-cell monitoring for HIV infection and AIDS. Flow-cytometry-derived DNA ploidy or S-phase fraction is medically necessary only in localized cancers without metastatic disease, namely endometrial adenocarcinoma, gastric cancer, mediastinal neuroblastoma, medulloblastoma, ovarian carcinoma, partial hydatidiform mole, prostatic adenocarcinoma, renal cell adenocarcinoma and urinary bladder carcinoma, and only when the prognostic information will affect treatment decisions. Ektacytometry is medically necessary for red blood cell cytoskeleton and hydration disorders when red blood cell morphology does not provide a clear diagnosis. The red blood cell adhesion index for all indications, DNA ploidy or S-phase testing in breast, cervical, colorectal, non-small cell lung, small cell lung and pediatric intracranial tumors, and microfluidic flow adhesion assays for sickle cell disease are experimental, investigational or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Teduglutide (Gattex) (CPB 0849, reviewed 2026-06-10)
Aetna's Clinical Policy Bulletin 0849 covers teduglutide (Gattex) for commercial medical plans and requires precertification from Aetna for participating providers and members in applicable plan designs. The drug must be prescribed by or in consultation with a gastroenterologist or a prescriber who specializes in short bowel syndrome. Aetna considers it medically necessary for short bowel syndrome in adults who have been dependent on parenteral nutrition and/or IV fluids for at least 12 months and receive them at least 3 times a week, or in members under 18 years of age who receive parenteral nutrition and/or IV fluids to account for at least 30% of caloric and/or fluid/electrolyte needs. Continuation is considered medically necessary when parenteral support requirements have decreased by at least 20% from baseline on therapy, or when the member has been weaned off parenteral support. Aetna considers all other indications experimental, investigational or unproven, including Crohn's disease, ulcerative colitis, graft-versus-host disease and type-2 diabetes mellitus.
Aetna · Identified Aug 15, 2026Medium impact
Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)
Aetna's Clinical Policy Bulletin 0815 covers ipilimumab (Yervoy) for commercial medical plans. It considers ipilimumab medically necessary for the cancer indications listed in the policy, many of them in combination with nivolumab, and considers continued treatment medically necessary for members requesting reauthorization when there is no evidence of unacceptable toxicity or disease progression. It considers ipilimumab experimental, investigational, or unproven for indications such as glioblastoma, pancreatic cancer, and prostate cancer, and for use with bevacizumab, vemurafenib, dabrafenib, or trametinib.
Aetna · Identified Aug 15, 2026Medium impact
Fam-trastuzumab Deruxtecan-nxki (Enhertu) (CPB 0966, reviewed 2026-05-15)
Aetna's policy for fam-trastuzumab deruxtecan-nxki (Enhertu) requires precertification from participating providers and members in applicable plan designs, and it covers the drug for commercial medical plans when the criteria for a listed indication are met. Listed indications include HER2-positive breast cancer, HER2-low and HER2-ultralow breast cancer, HER2-positive biliary tract cancer, HER2-positive esophageal, gastric or gastroesophageal junction adenocarcinoma, HER2-mutant non-small cell lung cancer, and HER2-positive (IHC 3+) solid tumors. Several indications are covered only when Enhertu is used as a single agent, and Aetna considers the drug experimental, investigational or unproven for all other indications.
Aetna · Identified Aug 14, 2026Medium impact
Endoscopic Ultrasonography (CPB 0446, reviewed 2026-07-22)
Aetna's Clinical Policy Bulletin 0446 sets coverage rules for endoscopic ultrasonography (EUS). Aetna considers EUS medically necessary for listed indications, including diagnosing common bile duct stones, evaluating abnormalities of the biliary tree and pancreas, staging tumors of the gastrointestinal tract, pancreas and bile ducts, staging lung cancer with fine-needle aspiration, pancreatic cancer screening in individuals with genetic susceptibility, and endoscopic ultrasound-guided biliary drainage for palliation of malignant biliary obstruction. EUS is considered experimental, investigational or unproven for all other indications, including diagnosis of esophageal varices, EUS-elastography, evaluation of common bile duct dilation in persons without signs or symptoms, and EUS-guided ablation therapies for pancreatic cystic neoplasms.
Aetna · Identified Aug 13, 2026Medium impact
Pemetrexed Products (CPB 0687, reviewed 2026-07-17)
Aetna considers pemetrexed (Alimta, Axtle, Pemfexy, Pemrydi RTU, or generic pemetrexed) medically necessary for commercial members with the listed indications: non-squamous non-small cell lung cancer, pleural and peritoneal mesothelioma, ovarian, fallopian tube and primary peritoneal cancer, cervical cancer, bladder cancer, primary CNS lymphoma, thymoma and thymic carcinoma, thyroid cancer, and vaginal cancer. Members with squamous cell non-small cell lung cancer are not eligible, and indications such as breast, colorectal, gastric, pancreatic and small cell lung cancer are experimental, investigational, or unproven. Continuation is covered when there is no unacceptable toxicity or disease progression, and use with pembrolizumab for pleural or peritoneal mesothelioma is covered for up to 24 months total.
Aetna · Identified Aug 13, 2026Medium impact
Dostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)
For commercial medical plan members, Aetna considers dostarlimab-gxly (Jemperli) medically necessary under its initial approval criteria for several mismatch repair deficient or microsatellite instability-high cancers, including endometrial, ampullary, breast, colorectal, esophageal, gastric, ovarian, pancreatic, small bowel and anal cancers. It also considers Jemperli in combination with pemetrexed and platinum chemotherapy for first-line metastatic nonsquamous non-small cell lung cancer without genomic aberrations. Members are not eligible when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)
Aetna considers durvalumab (Imfinzi) medically necessary for commercial medical plans when the criteria for a listed indication are met, and considers all other indications experimental, investigational, or unproven. Precertification is required of all Aetna participating providers and members in applicable plan designs, and Aetna considers members not eligible for Imfinzi when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy. Continuation of therapy is medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen, up to 12 months total for unresectable stage II or III NSCLC and up to 24 months total for limited stage SCLC.
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.
Aetna · Identified Nov 5, 2026Low impact
Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2026-10-29)
Aetna's Clinical Policy Bulletin 0811 (last reviewed 2026-10-29) confirms that autologous and allogeneic hematopoietic cell transplantation for most adult solid tumors is considered experimental, investigational, or unproven and not covered, with listed CPT, HCPCS, and ICD-10 codes marked as not covered for those indications. The only exceptions are young adults with primitive neuroectodermal tumors, medulloblastoma, and Ewing sarcoma family tumors, which fall under CPB 0496 criteria. The source states no specific effective date for a change; the listed effective date (02/04/2011) is the original policy date and the next review is 09/09/2027.

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11.03.18, Endoscopic Submucosal Dissection (ESD)

MA11.118, Endoscopic Submucosal Dissection (ESD)

11.03.18, Endoscopic Submucosal Dissection (ESD)

Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-10-16)

Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)

Docetaxel (CPB 0956, reviewed 2026-10-05)

Fam-trastuzumab Deruxtecan-nxki (Enhertu) (CPB 0966, reviewed 2026-09-17)

YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)

Tremelimumab-actl (Imjudo) (CPB 1019, reviewed 2026-04-27)

Trastuzumab Products (CPB 0313, reviewed 2026-06-08)

Tislelizumab-jsgr (Tevimbra) (CPB 1057, reviewed 2025-12-05)

Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)

Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-08-05)

Helicobacter Pylori Infection Testing (CPB 0177, reviewed 2026-03-20)

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

Flow Cytometry, Ektacytometry, DNA Ploidy, and S-phase Fraction (CPB 0351, reviewed 2026-05-21)

Teduglutide (Gattex) (CPB 0849, reviewed 2026-06-10)

Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)

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

Endoscopic Ultrasonography (CPB 0446, reviewed 2026-07-22)

Pemetrexed Products (CPB 0687, reviewed 2026-07-17)

Dostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)

Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)

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

Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2026-10-29)

What insurance policy changes affect code C16.0?

Which payers have updated policy for code C16.0?

How do I get notified when code C16.0 policy changes?

Why do payers change policies for code C16.0?