C22.2 Insurance Policy Changes

ICD-10 C22.2 is officially defined as "Hepatoblastoma." code C22.2 is referenced in 9 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 C22.2 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.
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 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
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 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
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
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.
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 C22.2?

There are 9 tracked policy changes affecting code C22.2, 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 C22.2?

Payers that have issued tracked updates for code C22.2 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code C22.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C22.2. 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 C22.2?

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 (CPB 0596, reviewed 2026-09-08)

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

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

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

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

Microwave Tumor Ablation

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

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

What insurance policy changes affect code C22.2?

Which payers have updated policy for code C22.2?

How do I get notified when code C22.2 policy changes?

Why do payers change policies for code C22.2?