What insurance policy changes affect code C24.1?

There are 4 tracked policy changes affecting code C24.1, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C24.1?

Payers that have issued tracked updates for code C24.1 include: Aetna.

How do I get notified when code C24.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C24.1. 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 C24.1?

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

C24.1 Insurance Policy Changes

ICD-10 C24.1 is officially defined as "Malignant neoplasm of ampulla of Vater." code C24.1 is referenced in 4 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C24.1 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Aug 15, 2026Medium impact
Irinotecan Liposome Injection (Onivyde) (CPB 0902, reviewed 2026-02-24)
Aetna covers Onivyde (irinotecan liposome injection) for commercial members with ampullary adenocarcinoma and for pancreatic adenocarcinoma when the listed criteria are met. Covered first-line use is as a component of NALIRIFOX (fluorouracil, leucovorin, liposomal irinotecan and oxaliplatin), and later-line use is in combination with fluorouracil and leucovorin, with the prior-therapy conditions the policy lists and good performance status (ECOG 0 to 1, or ECOG 2 in some pancreatic settings) with good biliary drainage and adequate nutritional intake. Continuation is covered when there is no evidence of unacceptable toxicity or disease progression, and all other indications, including biliary tract, brain, breast, colon, gastric, lung, ovarian and rectal cancers, are considered experimental, investigational or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Pancreaticoduodenectomy (Whipple Resection) (CPB 0365, reviewed 2026-05-22)
Aetna considers pancreaticoduodenectomy (Whipple resection) medically necessary for ampullary adenoma or carcinoma, cholangiocarcinoma, chronic pancreatitis, combined pancreatic and duodenal injury, duodenal neoplasm, intraductal papillary mucinous neoplasm of the pancreas with high-grade dysplasia or invasive cancer, neuroendocrine tumors, and pancreatic adenocarcinoma. Aetna considers Whipple resection experimental, investigational, or unproven for Zollinger-Ellison syndrome. Immuno-nutrition, intraoperative liquid biopsy for detecting R1 resection, intraoperative pancreas stump perfusion assessment, and pre-operative biliary drainage with an omental flap for preventing complications are listed as experimental, investigational, or unproven.
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
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.

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Irinotecan Liposome Injection (Onivyde) (CPB 0902, reviewed 2026-02-24)

Pancreaticoduodenectomy (Whipple Resection) (CPB 0365, reviewed 2026-05-22)

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

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

What insurance policy changes affect code C24.1?

Which payers have updated policy for code C24.1?

How do I get notified when code C24.1 policy changes?

Why do payers change policies for code C24.1?