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C22.0

PAYER POLICY CHANGES

C22.0 Insurance Policy Changes

ICD-10 C22.0 is officially defined as "Liver cell carcinoma." code C22.0 is referenced in 41 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C22.0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Radioembolization (TARE) for Hepatic Tumors 7.01.69
Excellus BlueCross BlueShield policy 7.01.69 considers transarterial radioembolization (TARE) with yttrium-90 microspheres medically necessary for unresectable or medically inoperable hepatocellular carcinoma, as a bridge to transplant for patients who meet liver transplant criteria and are waiting, for intrahepatic cholangiocarcinoma, and for unresectable metastatic hepatic tumors that meet the listed criteria (neuroendocrine tumors, colorectal, breast, and melanoma). A second TARE is considered medically necessary for a new, progressive tumor after a satisfactory response to an initial TARE, and a third TARE is considered not medically necessary. The version effective February 19, 2026 is an annual review with policy intent unchanged, following a 02/20/25 revision that added statements for primary intrahepatic cholangiocarcinoma and for metastatic hepatic tumors related to cutaneous melanoma.
Excellus BlueCross BlueShield · Effective Nov 20, 2025Medium impact
Liver Transplantation 7.02.07
Excellus BlueCross BlueShield policy 7.02.07 covers liver transplantation for selected people with end-stage liver disease when criteria are met. Listed indications include alcoholic cirrhosis, viral hepatitis, autoimmune hepatitis, primary hepatocellular carcinoma when the disease is organ confined and the patient is not a candidate for subtotal liver resection, and familial amyloid polyneuropathy. Cadaver recipients need a MELD score of 9 or greater, and living donor recipients need a MELD score from 9 to 25, a listing on the cadaveric liver transplant waiting list, and at least one significant complication of liver disease. The current effective date is November 20, 2025, and the policy history records an annual review with the policy intent unchanged.
Excellus BlueCross BlueShield · Effective Nov 16, 2025Medium impact
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12
Excellus BlueCross BlueShield stereotactic radiosurgery and stereotactic body radiation therapy medical policy 6.01.12 has a current effective date of November 16, 2025. Its October 16, 2025 annual review removed life expectancy criteria from the policy criteria. SRS is considered medically appropriate for specified benign, brain and neurologic indications, SBRT is considered medically appropriate for specified extracranial cancers and oligometastatic disease, and SBRT is considered not medically necessary for indications including extrahepatic bile duct cancer, gallbladder cancer and chronic pain.
Aetna · Identified Oct 18, 2026Medium impact
Ibritumomab Tiuxetan (Zevalin) (CPB 0659, reviewed 2026-10-15)
Aetna's Clinical Policy Bulletin 0659 covers ibritumomab tiuxetan (Zevalin) for commercial medical plans. Aetna considers it medically necessary for relapsed or refractory, low-grade or follicular B-cell non-Hodgkin lymphoma, and for previously untreated follicular non-Hodgkin lymphoma in members who have achieved a partial or complete response to first-line chemotherapy. Aetna considers all other indications experimental, investigational or unproven, and considers a repeat course of treatment not medically necessary.
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 6, 2026Medium impact
Liver Transplantation (CPB 0596, reviewed 2026-09-08)
Aetna considers orthotopic liver transplantation medically necessary for members with end-stage liver disease from the listed conditions who meet the criteria below. Adolescents 12 years of age or older and adults qualify with a MELD score greater than 10, approval by the UNOS Regional Review Board, or when they meet the transplant institution's selection criteria, and children under 12 qualify when they meet the transplanting institution's selection criteria. Liver transplantation is not medically necessary for absolute contraindications including active sepsis outside the biliary tract, inability to adhere to the transplant regimen (including homelessness, active substance abuse, and unstable psychiatric disease or psychosocial problem), presence of other effective treatments or surgical options, and significant organ system failure other than kidney, liver or small bowel.
Aetna · Identified Oct 3, 2026Medium impact
Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-09-18)
Aetna considers percutaneous ethanol injection (PEI) medically necessary for hepatocellular carcinoma (HCC) without extra-hepatic spread and for neuroendocrine cancers involving the liver. Chemoembolization is medically necessary for neuroendocrine cancers involving the liver, unresectable primary HCC, liver-only metastasis from uveal melanoma, and pre-operative hepatic artery chemoembolization followed by orthotopic liver transplantation for HCC. Intra-hepatic microspheres (TheraSphere, SIR-Spheres, also known as trans-arterial radio-embolization) are medically necessary for neuroendocrine cancers involving the liver, unresectable primary HCC, unresectable liver tumors from primary colorectal cancer, unresectable and chemo-refractory intra-hepatic cholangiocarcinoma with liver metastases only, and pre-operative use as a bridge to orthotopic liver transplantation for HCC. Intra-hepatic chemotherapy is medically necessary for members with liver metastases from colorectal cancer. Many other uses are listed as experimental, investigational or unproven, including chemoembolization for palliative treatment of liver metastases from non-neuroendocrine primaries, PEI for liver neoplasms when the criteria above are not met, combined electrochemotherapy and immunotherapy for HCC, the TriNav Infusion System, the TheraBionic P1 System, and degradable starch microsphere chemoembolization for HCC.
Aetna · Identified Aug 19, 2026Medium impact
Infusion Pumps (CPB 0161, reviewed 2026-03-31)
Aetna Clinical Policy Bulletin 0161 sets the medical necessity criteria for implantable infusion pumps, including intrathecal baclofen for severe spasticity of cerebral or spinal origin, intrathecal or epidural opioids, ziconotide and clonidine for severe chronic intractable pain, and intrahepatic chemotherapy for primary hepatocellular carcinoma and for colorectal cancer metastases limited to the liver. It also covers external infusion pumps for listed drugs, including certain chemotherapy, antifungal and antiviral drugs, heparin, deferoxamine, morphine for intractable cancer pain, and insulin for members with diabetes who meet the stated criteria, and it lists the CPT, HCPCS and ICD-10 codes that are covered when criteria are met and those not covered for the listed indications.
Aetna · Identified Aug 19, 2026Medium impact
Liver Transplantation (CPB 0596, reviewed 2026-03-02)
Aetna considers orthotopic liver transplantation medically necessary for members with end-stage liver disease from the listed conditions who meet the policy's medical necessity criteria. For adolescents 12 or older and adults, the criteria are a MELD score greater than 10, approval by a UNOS Regional Review Board, or meeting the transplant institution's selection criteria. Children under 12 are covered when they meet the transplanting institution's selection criteria. The policy also covers primary hepatocellular carcinoma confined to the liver that meets listed criteria, retransplantation after a failed transplant performed for a covered indication, normothermic machine perfusion of the transplanted liver, and compatibility testing for living donors. Absolute contraindications include active sepsis outside the biliary tract, inability to adhere to the transplant regimen, and significant organ system failure other than kidney, liver or small bowel failure. Liver transplantation for malignancies other than those listed, and several perfusion, biomarker and support-system uses, are described as experimental, investigational or unproven.
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
Transjugular Intrahepatic Portosystemic Shunt (TIPSS) (CPB 0259, reviewed 2026-04-14)
Aetna considers transjugular intrahepatic portosystemic shunt (TIPSS) medically necessary for bleeding gastric, esophageal or ectopic varices, moderate Budd-Chiari syndrome that has failed to respond to anticoagulation, portal hypertensive gastropathy with recurrent bleeding despite beta-blockers, severe refractory ascites in people who are intolerant of repeated large volume paracentesis, and refractory hepatic hydrothorax, when the member meets the selection criteria in the Appendix. TIPSS is experimental, investigational, or unproven for all other indications, including initial therapy for acute variceal hemorrhage, prophylaxis of variceal hemorrhage, and hepatorenal syndrome.
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
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
ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)
Aetna considers the ADAMTS13 assay medically necessary for assessing prognosis in persons with thrombotic thrombocytopenic purpura (TTP), and for distinguishing hematopoietic stem cell transplant-associated thrombotic microangiopathy (HSCT-TMA, also called transplant-associated TMA) from TTP in persons with overlapping features when the test will be used to inform treatment. Aetna considers the assay experimental, investigational, or unproven for the uses it lists because of insufficient evidence, including sepsis-associated thrombotic microangiopathy, hemolytic uremic syndrome, acute myelogenous leukemia, colorectal cancer survival, COVID-19, cerebral infarction, and ADAMTS13 mutation testing for non-cirrhotic portal hypertension.
Aetna · Identified Aug 17, 2026Medium impact
Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-04-16)
Aetna considers percutaneous ethanol injection, chemoembolization, intra-hepatic chemotherapy and intra-hepatic microspheres (also called TARE) medically necessary for listed liver indications. These include unresectable primary hepatocellular carcinoma (HCC), neuroendocrine tumors involving the liver, liver-only metastasis from uveal melanoma, unresectable liver tumors from colorectal cancer, and pre-operative use before liver transplantation for HCC. The policy considers many other uses experimental, investigational or unproven, including chemoembolization for liver metastases from non-neuroendocrine primaries, combined radiofrequency ablation and percutaneous ethanol injection for HCC, drug-eluting beads for liver metastases from colorectal cancer, the TriNav Infusion System and the TheraBionic P1 System.
Aetna · Identified Aug 17, 2026Medium impact
Suction Pumps (CPB 0503, reviewed 2026-07-02)
Aetna considers home model respiratory suction pumps medically necessary as durable medical equipment for members who have difficulty raising and clearing secretions because of cancer or surgery of the throat or mouth, dysfunction of the swallowing muscles, a tracheostomy, or unconsciousness or an obtunded state. Gastric suction pumps are medically necessary for members who are unable to empty gastric secretions through normal gastrointestinal functions. Wound suction is considered medically necessary only when the quantity of exudate exceeds the capacity of conservative measures such as surgical dressings and wound fillers to contain it. Aetna considers subcutaneous peritoneal ascites pumps such as the alfa-pump System experimental, investigational, or unproven for managing ascites and for the other indications the policy lists.
Aetna · Identified Aug 17, 2026Medium impact
Microwave Thermotherapy (CPB 0682, reviewed 2025-10-15)
Aetna considers microwave thermotherapy medically necessary for clinical stage T1 renal lesions, for medically inoperable non-small cell lung cancer lesions less than 3 cm, and for hepatocellular carcinoma tumors less than or equal to 3 cm. Aetna considers microwave thermotherapy experimental, investigational or unproven for bladder cancer, bone cancer and limb salvage, breast cancer and breast cancer metastasis, cervical ectopy, chronic low back and neck pain, chronic pelvic pain syndrome, chronic prostatitis, cutaneous verrucae, dysmenorrhea, endometrial cancer, keratoconus, nasopharyngeal cancer, osteosarcoma, pancreatic cancer, rheumatoid arthritis and vulvar lichen sclerosus. Microwave thermotherapy enhanced with hybrid magnetic nanoparticles for liver cancer and microwave thermotherapy combined with TIPE2 for colon cancer are also experimental, investigational or unproven.
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
Ibritumomab Tiuxetan (Zevalin) (CPB 0659, reviewed 2025-11-26)
Aetna considers ibritumomab tiuxetan (Zevalin) medically necessary for relapsed or refractory, low-grade or follicular B-cell non-Hodgkin's lymphoma (NHL), and for previously untreated follicular NHL in members who have achieved a partial or complete response to first-line chemotherapy. Aetna considers a repeat course of treatment not medically necessary and all other indications experimental, investigational, or unproven. This policy applies to commercial medical plans, and Medicare criteria are in a separate Medicare Part B Criteria document.
Aetna · Identified Aug 15, 2026Medium impact
Ramucirumab (Cyramza) (CPB 0883, reviewed 2026-06-03)
Aetna requires precertification for ramucirumab (Cyramza) for all participating providers and members in applicable commercial plan designs. Aetna considers ramucirumab medically necessary for gastric, gastro-esophageal junction, and esophageal adenocarcinoma in members who are not surgical candidates or have unresectable locally advanced, recurrent or metastatic disease, and for NSCLC, advanced colorectal cancer with FOLFIRI or irinotecan, hepatocellular carcinoma with AFP of at least 400 ng/mL, mesothelioma with gemcitabine, and thymic carcinoma in the specified carboplatin and paclitaxel settings. Aetna considers ramucirumab experimental, investigational, or unproven for other indications, including breast, ovarian, prostate and renal cell cancers, head and neck cancer, melanoma and rheumatoid arthritis.
Aetna · Identified Aug 15, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-07-29)
Aetna considers radiofrequency ablation (RFA) medically necessary for several tumor indications, including colorectal cancer liver metastases, colorectal lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), and malignant lung masses in persons who are not candidates for surgical intervention. Solitary hepatocellular carcinoma of 5 cm or less is covered in members who are ineligible for or decline surgical resection or transplantation, and renal cell carcinoma up to 4 cm is covered in high-risk surgical candidates, persons with renal insufficiency, or persons with a solitary kidney. The policy lists curative RFA of malignant neoplasms in persons who are able to tolerate surgical resection, combined RFA with trans-arterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, and combined RFA with vertebral cement augmentation for spinal metastases as experimental, investigational, or unproven.
Aetna · Identified Aug 14, 2026Medium impact
Embolization: Selected Procedures (CPB 0856, reviewed 2026-01-12)
Aetna considers alcohol embolization or sclerotherapy and/or surgery for symptomatic venous malformations medically necessary when there is pain, swelling, ulceration, or hemorrhage. Coil embolization is medically necessary for arterio-venous malformations and aneurysms, congenital aorto-azygous fistula, splenic artery aneurysm and gastric varices, and embolization is medically necessary for lower gastro-intestinal bleeding, for renal angiomyolipoma with active bleeding or a size greater than 6 cm, and for several other listed indications. Aetna considers hemorrhoidal embolization, endovascular lymphatic ablation, Onyx embolization for the treatment of CSF vertebral vein fistula, coil embolization of the hypogastric veins for deep vein thrombosis, and several other listed procedures experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)
Aetna considers photodynamic therapy with porfimer sodium (Photofrin) medically necessary for esophageal cancer, endobronchial non-small cell lung cancer and inoperable cholangiocarcinoma (as an adjunct to stenting) when the listed criteria are met, and experimental, investigational or unproven when they are not. Photodynamic therapy with topical photosensitizers such as methyl aminolevulinate, topical 5-fluorouracil and aminolevulinic acid is medically necessary for basal cell carcinoma, cutaneous lesions of Bowen's disease, refractory actinic keratoses, low-risk squamous cell carcinoma in situ where surgery or radiation is contraindicated or impractical, and erythroplasia of Queyrat. Photodynamic therapy is considered experimental, investigational or unproven for other cancers and for a long list of non-cancer indications, and the policy applies to commercial medical plans.
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 Aug 12, 2026Medium impact
Cetuximab (Erbitux) (CPB 0684, reviewed 2025-12-03)
Aetna's commercial medical policy CPB 0684 covers cetuximab (Erbitux) for listed cancers when the member meets the criteria for that indication. Covered indications are colorectal cancer, head and neck cancer, non-small cell lung cancer, penile cancer and squamous cell skin cancer, each with its own conditions. Precertification is required. Aetna considers all other indications experimental, investigational or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Bevacizumab for Non-Ocular Indications (CPB 0685, reviewed 2026-04-07)
Aetna Clinical Policy Bulletin 0685 covers bevacizumab (Avastin) and its biosimilars for non-ocular indications under commercial medical plans. Aetna considers these products medically necessary for ampullary adenocarcinoma, appendiceal neoplasms and cancers, central nervous system cancers, cervical cancer, colorectal cancer including appendiceal and anal adenocarcinoma, stage III-IV endometrial carcinoma, hepatocellular carcinoma when used with atezolizumab, mesothelioma, non-squamous non-small cell lung cancer, ovarian, fallopian tube and primary peritoneal cancer, relapsed or stage IV renal cell carcinoma, small bowel adenocarcinoma, soft tissue sarcoma, vaginal cancer, and vulvar cancer. Aetna considers all other non-ocular indications as experimental, investigational, or unproven. The policy was last reviewed 04/07/2026.
Aetna · Identified Aug 12, 2026Medium impact
Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (CPB 0909, reviewed 2026-06-30)
Aetna's commercial coverage policy for atezolizumab (Tecentriq) and atezolizumab and hyaluronidase-tqjs (Tecentriq Hybreza) covers them for specific indications when the criteria are met. Covered indications include recurrent, advanced or metastatic non-small cell lung cancer, extensive-stage small cell lung cancer, hepatocellular carcinoma in combination with bevacizumab, BRAF V600 mutation-positive melanoma in combination with cobimetinib and vemurafenib, alveolar soft part sarcoma, and adjuvant treatment of muscle invasive bladder cancer after cystectomy when the member is positive for circulating tumor DNA molecular residual disease. Precertification is required in applicable plan designs, and the Site of Care Utilization Management Policy applies. Use for all other indications is considered experimental, investigational, or unproven, and members are not eligible after disease progression on PD-1 or PD-L1 inhibitor therapy.
Aetna · Identified Aug 12, 2026Medium impact
Ablation of Hepatic Lesions (CPB 0274, reviewed 2026-06-08)
Aetna considers cryosurgery, microwave, or conventional tumor-puncture nonpulsed radiofrequency ablation of liver tumors medically necessary for members with isolated colorectal cancer liver metastases or isolated hepatocellular cancer who are not candidates for open surgical resection, when all selection criteria are met. The criteria require that all liver tumors seen on pre-operative imaging would be potentially destroyed by the ablation, and that liver lesions be 4 cm or less in diameter and occupy less than 50% of the liver parenchyma. Aetna considers these ablation methods experimental, investigational, or unproven when the criteria are not met, and lists histotripsy, no-touch radiofrequency ablation, percutaneous irreversible electroporation for inoperable colorectal liver metastases, microwave ablation of hepatic adenoma and hemangioma, and percutaneous thermal segmentectomy as experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
Transcatheter arterial chemoembolization of the liver may be considered medically necessary to treat unresectable hepatocellular cancer confined to the liver, as a bridge to transplant, to treat symptomatic liver metastases from neuroendocrine tumors that persist despite systemic therapy, and to treat liver-dominant metastatic uveal melanoma. It is considered investigational as neoadjuvant or adjuvant therapy for resectable hepatocellular cancer, as part of combination therapy with radiofrequency ablation, for unresectable intrahepatic cholangiocarcinoma, and for other liver metastases or hepatocellular cancer not meeting the criteria above. The policy history records a 09/12/2025 review with no changes.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Radioembolization for Primary and Metastatic Tumors of the Liver
The policy considers yttrium-90 microsphere radioembolization medically necessary for primary hepatocellular carcinoma that is unresectable and limited to the liver, as a bridge to liver transplantation, and for primary intrahepatic cholangiocarcinoma in individuals with unresectable tumors. It also considers radioembolization medically necessary for hepatic metastases from neuroendocrine tumors with diffuse and symptomatic disease when systemic therapy has failed to control symptoms. It may be considered medically necessary for unresectable hepatic metastases from colorectal carcinoma, melanoma (ocular or cutaneous), or breast cancer that are both progressive and diffuse, in individuals with liver-dominant disease who are refractory to chemotherapy or are not candidates for chemotherapy or other systemic therapies. Radioembolization is investigational for all other hepatic metastases and for all other indications not described.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Radiofrequency ablation of inoperable hepatocellular carcinoma may be considered medically necessary as a primary treatment when the tumor meets the Milan criteria (a single tumor of 5 cm or less, or up to 3 nodules under 3 cm), and as a bridge to liver transplant when the intent is to prevent further tumor growth and maintain candidacy for transplant. For inoperable hepatic metastases, it may be considered medically necessary when the metastases are of colorectal origin and meet the Milan criteria, or of neuroendocrine origin and systemic therapy has failed to control symptoms. Ablation of operable hepatocellular carcinoma, of more than three nodules or when not all tumor foci can be adequately treated, of hepatocellular carcinoma used to downstage for transplant, and of hepatic metastases from other cancers except colorectal or neuroendocrine tumors is considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Microwave Tumor Ablation
This Blue Cross Blue Shield Association policy states that microwave ablation of primary or metastatic liver tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 5 cm or less or up to 3 nodules of 3 cm or less each. Microwave ablation of primary or metastatic lung tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 3 cm or less. Microwave ablation of more than a single lung tumor, and of primary or metastatic tumors other than liver or lung, is considered investigational.
Independence Blue Cross · Effective Jul 9, 2025Low impact
07.00.10j, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
Independence Blue Cross reissued PDT policy 07.00.10j on 07/09/2025 with no substantive changes to coverage criteria. Three CPT codes (96567, 96573, 96999) were added and four ICD-10 diagnosis codes (C23, D13.0, D37.8, D37.9) were removed. The policy maintains coverage for PDT using porfimer sodium for Barrett's esophagus, esophageal cancer, cholangiocarcinoma, endobronchial lung cancer, and specific skin conditions.
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.
Aetna · Identified Nov 4, 2026Low impact
Microwave Thermotherapy (CPB 0682, reviewed 2026-10-26)
Aetna's Microwave Thermotherapy policy (CPB 0682) was reviewed on 2026-10-26, and the source does not state what changed or give a new effective date. It covers microwave thermotherapy as medically necessary only for T1 renal lesions, medically inoperable non-small cell lung cancer lesions under 3 cm, and hepatocellular carcinoma tumors of 3 cm or less, and it lists many other uses (such as breast, pancreatic, bladder, and chronic pain indications) as experimental, investigational or unproven.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA07.030c, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)
This is an annual policy reissue with no substantive changes to coverage criteria for Photodynamic Therapy using Porfimer Sodium (Photofrin®). The policy was reissued on 07/09/2025 in accordance with Independence Blue Cross's standard annual review process. No updates to covered indications, billing codes, or medical necessity criteria have been made.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C22.0?

There are 41 tracked policy changes affecting code C22.0, including updates from Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C22.0?

Payers that have issued tracked updates for code C22.0 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code C22.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C22.0. 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 C22.0?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Radioembolization (TARE) for Hepatic Tumors 7.01.69

Liver Transplantation 7.02.07

Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12

Ibritumomab Tiuxetan (Zevalin) (CPB 0659, reviewed 2026-10-15)

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

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

Liver Transplantation (CPB 0596, reviewed 2026-09-08)

Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-09-18)

Infusion Pumps (CPB 0161, reviewed 2026-03-31)

Liver Transplantation (CPB 0596, reviewed 2026-03-02)

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

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

Transjugular Intrahepatic Portosystemic Shunt (TIPSS) (CPB 0259, reviewed 2026-04-14)

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

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

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

ADAMTS13 Assay for Thrombotic Thrombocytopenic Purpura (TTP) (CPB 0780, reviewed 2026-04-27)

Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-04-16)

Suction Pumps (CPB 0503, reviewed 2026-07-02)

Microwave Thermotherapy (CPB 0682, reviewed 2025-10-15)

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

Ibritumomab Tiuxetan (Zevalin) (CPB 0659, reviewed 2025-11-26)

Ramucirumab (Cyramza) (CPB 0883, reviewed 2026-06-03)

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-07-29)

Embolization: Selected Procedures (CPB 0856, reviewed 2026-01-12)

Photodynamic Therapy (CPB 0375, reviewed 2026-05-21)

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)

Cetuximab (Erbitux) (CPB 0684, reviewed 2025-12-03)

Bevacizumab for Non-Ocular Indications (CPB 0685, reviewed 2026-04-07)

Atezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (CPB 0909, reviewed 2026-06-30)

Ablation of Hepatic Lesions (CPB 0274, reviewed 2026-06-08)

Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies

Radioembolization for Primary and Metastatic Tumors of the Liver

Radiofrequency Ablation of Primary or Metastatic Liver Tumors

Microwave Tumor Ablation

07.00.10j, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)

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

Microwave Thermotherapy (CPB 0682, reviewed 2026-10-26)

MA07.030c, Photodynamic Therapy (PDT) Using Porfimer Sodium (Photofrin®)

What insurance policy changes affect code C22.0?

Which payers have updated policy for code C22.0?

How do I get notified when code C22.0 policy changes?

Why do payers change policies for code C22.0?