What insurance policy changes affect code C38.4?

There are 3 tracked policy changes affecting code C38.4, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C38.4?

Payers that have issued tracked updates for code C38.4 include: Aetna.

How do I get notified when code C38.4 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C38.4. 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 C38.4?

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

C38.4 Insurance Policy Changes

ICD-10 C38.4 is officially defined as "Malignant neoplasm of pleura." code C38.4 is referenced in 3 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 C38.4 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
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 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 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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Ramucirumab (Cyramza) (CPB 0883, reviewed 2026-06-03)

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

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

What insurance policy changes affect code C38.4?

Which payers have updated policy for code C38.4?

How do I get notified when code C38.4 policy changes?

Why do payers change policies for code C38.4?