C45.1 Insurance Policy Changes

ICD-10 C45.1 is officially defined as "Mesothelioma of peritoneum." code C45.1 is referenced in 12 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C45.1 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Jun 16, 2025Medium impact
MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Independence Blue Cross Medicare Advantage has expanded HIPEC (hyperthermic intraperitoneal chemotherapy) coverage to include peritoneal carcinomatosis of gastric origin as medically necessary (previously experimental). The policy also refined ovarian/fallopian tube cancer coverage headers and removed eight ICD-10 codes. Effective June 16, 2025, gastric peritoneal carcinomatosis claims now require specific criteria: PCI ≤10, no extraperitoneal metastasis, and expected complete cytoreduction.
Independence Blue Cross · Effective Jun 16, 2025Medium impact
11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
Independence Blue Cross expanded coverage for hyperthermic intraperitoneal chemotherapy (HIPEC) by reclassifying peritoneal carcinomatosis of gastric origin from experimental/investigational to medically necessary, effective June 16, 2025. The policy also clarified coverage headers for ovarian, fallopian tube, and primary peritoneal cancers, and removed 8 ICD-10 diagnosis codes from the policy document.
Independence Blue Cross · Effective Jun 16, 2025Medium impact
MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Independence Blue Cross Medicare Advantage policy MA07.017g has been reissued with expanded coverage for HIPEC (hyperthermic intraperitoneal chemotherapy). Key change: peritoneal carcinomatosis of gastric origin moved from experimental/investigational to medically necessary status, effective June 16, 2025. Eight ICD-10 codes were removed from the policy. Coverage criteria now include specific requirements for gastric origin cases (PCI ≤10, no extraperitoneal metastasis, expected complete cytoreduction).
Independence Blue Cross · Effective Jun 16, 2025Medium impact
11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies
Independence Blue Cross expanded coverage for HIPEC (hyperthermic intraperitoneal chemotherapy) by reclassifying gastric peritoneal carcinomatosis from experimental/investigational to medically necessary, effective June 16, 2025. The policy also clarified ovarian/fallopian tube cancer coverage and removed 8 ICD-10 codes that are no longer applicable to this procedure.
Aetna · Identified Aug 19, 2026Medium impact
Zoledronic Acid (CPB 0524, reviewed 2026-02-12)
Aetna's clinical policy bulletin covers zoledronic acid for commercial medical plans. Zoledronic acid 5 mg (Reclast or generic) is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget's disease of bone, and treatment-related bone loss in men with prostate cancer receiving androgen deprivation therapy, when the listed criteria are met. Zoledronic acid 4 mg (formerly branded Zometa) is considered medically necessary for bone metastases from a solid tumor, certain breast cancer indications, hypercalcemia of malignancy, Langerhans cell histiocytosis with bone disease, multiple myeloma, and systemic mastocytosis with osteopenia or osteoporosis. Aetna considers all other indications 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
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 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 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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors
Single autologous hematopoietic cell transplantation may be considered medically necessary as salvage therapy for germ cell tumors in individuals with favorable prognostic factors who have failed a previous course of conventional-dose salvage chemotherapy, and in individuals with unfavorable prognostic factors as initial treatment of first relapse or with platinum-refractory disease. Tandem autologous transplant or transplant with sequential high-dose chemotherapy may be considered medically necessary for testicular tumors as salvage therapy or with platinum-refractory disease, while autologous transplant as a component of first-line treatment and allogeneic transplant to treat germ cell tumors are considered investigational. The policy history records a review on 07/27/2026 with policy statements unchanged and ICD-9 procedure and diagnosis codes removed from the Code Reference section.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies
Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC) at the time of surgery may be considered medically necessary for pseudomyxoma peritonei and diffuse malignant peritoneal mesothelioma. For newly diagnosed epithelial ovarian or fallopian tube cancer, HIPEC at interval cytoreductive surgery may be considered medically necessary only when all listed criteria are met: stage III disease, ineligibility for primary cytoreductive surgery (or incomplete surgery followed by neoadjuvant chemotherapy and interval debulking surgery), and expected complete or optimal cytoreduction. HIPEC in all other ovarian cancer settings, including stage IIIC or IV, cytoreductive surgery plus HIPEC for peritoneal carcinomatosis from colorectal, gastric or endometrial cancer, and all other indications, including goblet cell tumors of the appendix, are considered investigational.

Watch C45.1

Get one email when a payer policy names C45.1, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C45.1?

There are 12 tracked policy changes affecting code C45.1, including updates from Independence Blue Cross, 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 C45.1?

Payers that have issued tracked updates for code C45.1 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C45.1 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C45.1. 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 C45.1?

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

Get alerts for changes like this

Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.

Create a free alert How Policy Monitoring works

MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies

MA07.017g, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

11.00.13k, Hyperthermic Intraperitoneal Chemotherapy for Select Intra-abdominal and Pelvic Malignancies

Zoledronic Acid (CPB 0524, reviewed 2026-02-12)

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

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

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

Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)

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

Hematopoietic Cell Transplantation in the Treatment of Germ Cell Tumors

Hyperthermic Intraperitoneal Chemotherapy for Select Intra-Abdominal and Pelvic Malignancies

What insurance policy changes affect code C45.1?

Which payers have updated policy for code C45.1?

How do I get notified when code C45.1 policy changes?

Why do payers change policies for code C45.1?