C48.0 Insurance Policy Changes

ICD-10 C48.0 is officially defined as "Malignant neoplasm of retroperitoneum." code C48.0 is referenced in 15 tracked payer policy changes from Excellus BlueCross BlueShield, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C48.0 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 Jun 15, 2026Medium impact
Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT) - (Effective Date - 2026-06-15) 7.02.03
Effective June 15, 2026, autologous hematopoietic stem cell transplantation (auto-HSCT) is considered medically appropriate when the transplanting institution's selection criteria are met, the multidisciplinary team recommends treatment, and the individual meets the indication-specific criteria listed in the policy. Those criteria cover blood and plasma cancers, solid tumors, multiple sclerosis, systemic sclerosis and juvenile rheumatoid arthritis, and auto-HSCT is considered investigational for all other indications. The February 19, 2026 annual review updated the indications and criteria to align with American Society for Transplantation and Cellular Therapy guidelines.
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.
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 Oct 18, 2026Medium impact
Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-10-14)
Aetna considers gonadotropin-releasing hormone (GnRH) analogs and antagonists medically necessary for commercial plan members only for the specific indications listed for each drug, including leuprolide, goserelin, histrelin, triptorelin, degarelix, cetrorelix and ganirelix, and treats all other indications as experimental, investigational or unproven. Each drug has separate criteria for initial approval and for continuation of therapy, and continuation for prostate cancer requires clinical benefit such as serum testosterone less than 50 ng/dL and no unacceptable toxicity. Precertification is required for the prostate cancer indication, and gender dysphoria treatment for members under 18 must be prescribed by or in consultation with a provider specialized in the care of transgender youth who has collaborated care with a mental health provider.
Aetna · Identified Aug 18, 2026Medium impact
Trabectedin (Yondelis) (CPB 0903, reviewed 2026-01-13)
Aetna covers trabectedin (Yondelis) for commercial medical plans when the criteria for the listed sarcoma indications are met. Covered indications include advanced, recurrent/metastatic or inoperable leiomyosarcoma (first-line in combination with doxorubicin, or second-line or later as a single agent), certain soft tissue sarcomas, pleomorphic rhabdomyosarcoma, solitary fibrous tumor, dedifferentiated liposarcoma and epithelioid hemangioendothelioma. Continuation of trabectedin is medically necessary for a listed indication while there is no evidence of unacceptable toxicity or disease progression on the current regimen, and all other indications are considered experimental, investigational or unproven. This is dated 2026-01-13, so check current applicability before acting.
Aetna · Identified Aug 17, 2026Medium impact
Temozolomide (Temodar) Injection (CPB 0876, reviewed 2026-06-03)
Aetna's Clinical Policy Bulletin 0876 considers temozolomide (Temodar) injection medically necessary for brain metastases from solid tumors, metastatic or unresectable cutaneous melanoma as single agent subsequent therapy, second-line Ewing sarcoma in combination with irinotecan with or without vincristine, mycosis fungoides or Sezary syndrome with CNS involvement as single agent subsequent therapy, high-risk neuroblastoma in combination with irinotecan, dinutuximab and sargramostim or with irinotecan, naxitamab-gqgk and sargramostim, unresectable or metastatic pheochromocytoma or paraganglioma as single agent first-line therapy, relapsed or primary progressive small cell lung cancer as single agent subsequent therapy, advanced, recurrent, metastatic or inoperable uterine sarcoma as single agent subsequent therapy, and unresectable or metastatic uveal melanoma as a single agent. Aetna considers all other indications experimental, investigational or unproven, including chronic lymphocytic leukemia, diffuse large B-cell lymphoma, metastatic colorectal cancer and pituitary tumors. Continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
Aetna · Identified Aug 15, 2026Medium impact
Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-07-10)
Aetna covers gonadotropin-releasing hormone (GnRH) analogs and antagonists under its commercial medical plans for the indications the policy lists, including prostate cancer, breast cancer, ovarian cancer, central precocious puberty, endometriosis, uterine leiomyomata (fibroids), and ovulation induction or assisted reproductive technology. The policy also sets criteria for gender dysphoria treatment, including pubertal suppression in adolescents and gender transition, and for continuation of therapy. Aetna considers all other indications 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.
Aetna · Identified Aug 13, 2026Medium impact
Eribulin Mesylate (Halaven) (CPB 0831, reviewed 2026-06-19)
Aetna covers eribulin mesylate (Halaven) as single-agent therapy for recurrent unresectable or metastatic breast cancer when the disease is HER2-negative, or in combination with margetuximab-cmkb or trastuzumab for HER2-positive disease as fourth line therapy and beyond. Single-agent use is also covered for dedifferentiated liposarcoma with or without concurrent well-differentiated liposarcoma, epithelioid hemangioendothelioma, extremity/body wall or head/neck, pleomorphic rhabdomyosarcoma, and retroperitoneal/intra-abdominal soft tissue sarcoma. Continuation of therapy is covered when there is no evidence of unacceptable toxicity or disease progression on the current regimen, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Dostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)
For commercial medical plan members, Aetna considers dostarlimab-gxly (Jemperli) medically necessary under its initial approval criteria for several mismatch repair deficient or microsatellite instability-high cancers, including endometrial, ampullary, breast, colorectal, esophageal, gastric, ovarian, pancreatic, small bowel and anal cancers. It also considers Jemperli in combination with pemetrexed and platinum chemotherapy for first-line metastatic nonsquamous non-small cell lung cancer without genomic aberrations. Members are not eligible when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy, and all other indications are considered experimental, investigational, or unproven.
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C48.0?

There are 15 tracked policy changes affecting code C48.0, including updates from Excellus BlueCross BlueShield, Independence Blue Cross, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C48.0?

Payers that have issued tracked updates for code C48.0 include: Excellus BlueCross BlueShield, Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C48.0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C48.0. 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 C48.0?

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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Autologous Hematopoietic Stem Cell Transplantation (Auto-HSCT) - (Effective Date - 2026-06-15) 7.02.03

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02

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

Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-10-14)

Trabectedin (Yondelis) (CPB 0903, reviewed 2026-01-13)

Temozolomide (Temodar) Injection (CPB 0876, reviewed 2026-06-03)

Gonadotropin-Releasing Hormone Analogs and Antagonists (CPB 0501, reviewed 2026-07-10)

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

Eribulin Mesylate (Halaven) (CPB 0831, reviewed 2026-06-19)

Dostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)

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 C48.0?

Which payers have updated policy for code C48.0?

How do I get notified when code C48.0 policy changes?

Why do payers change policies for code C48.0?