ICD-10 C45.2 is officially defined as "Mesothelioma of pericardium." code C45.2 is referenced in 5 tracked payer policy changes from Independence Blue Cross and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C45.2 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross updated pemetrexed (Pemfexy) policy 08.00.87p to align with FDA labeling and NCCN guidelines, adding coverage for Malignant Peritoneal Mesothelioma subtypes and Low-Grade Serous Carcinoma, while removing non-specific lung cancer ICD-10 codes and the Head and Neck Cancer indication. Billing teams must update diagnosis code requirements and remove deprecated codes from claim submissions.
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 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 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 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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