C38.1 Insurance Policy Changes

ICD-10 C38.1 is officially defined as "Malignant neoplasm of anterior mediastinum." code C38.1 is referenced in 4 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C38.1 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
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02
Excellus medical policy 7.02.02 sets when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered medically appropriate. It applies when the candidate meets the transplanting institution's selection criteria, the multidisciplinary team evaluates the individual and recommends treatment, and the individual is treated for one of the listed indications. The listed indications include acute and chronic leukemias, non-Hodgkin lymphoma, myelodysplastic diseases at intermediate or high risk, sickle cell anemia under stated criteria, transfusion-dependent thalassemia, bone marrow failure syndromes, severe combined immunodeficiency, hemophagocytic disorders, several storage and leukodystrophy disorders, and certain skeletal and metabolic bone disorders. Allo-HSCT is considered investigational for all other indications. The February 19, 2026 revision simplified the criteria to the indication level, removed the investigational indications list and added HCPCS code S2142.
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 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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation for Solid Tumors of Childhood
Autologous hematopoietic cell transplantation may be considered medically necessary at initial treatment of high-risk neuroblastoma and high-risk Ewing sarcoma, for recurrent or refractory neuroblastoma and Ewing sarcoma, and for metastatic retinoblastoma. Tandem autologous transplant may be considered medically necessary for high-risk neuroblastoma. Autologous transplant is considered investigational as initial treatment of low- or intermediate-risk neuroblastoma and Ewing sarcoma and for rhabdomyosarcoma, Wilms tumor, osteosarcoma and retinoblastoma without metastasis, and allogeneic transplant for pediatric solid tumors and salvage allogeneic transplant after relapse or failure of response to autologous transplant are considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C38.1?

There are 4 tracked policy changes affecting code C38.1, 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 C38.1?

Payers that have issued tracked updates for code C38.1 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C38.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C38.1. 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 C38.1?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02

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

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

Hematopoietic Cell Transplantation for Solid Tumors of Childhood

What insurance policy changes affect code C38.1?

Which payers have updated policy for code C38.1?

How do I get notified when code C38.1 policy changes?

Why do payers change policies for code C38.1?