C49.A9 Insurance Policy Changes

ICD-10 C49.A9 is officially defined as "Gastrointestinal stromal tumor of other sites." code C49.A9 is referenced in 7 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C49.A9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 29, 2026Medium impact
Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)
Aetna's Clinical Policy Bulletin 0747, last reviewed 10/21/2026, covers transanal endoscopic microsurgery (TEM). Aetna considers TEM medically necessary for benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter. Aetna considers TEM experimental, investigational, or unproven for other indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, and megacolon. The source text does not describe what changed in this review.
Aetna · Identified Oct 8, 2026Medium impact
Docetaxel (CPB 0956, reviewed 2026-10-05)
For commercial medical plans, docetaxel (Beizray, Docivyx, Taxotere, or generic docetaxel) is considered medically necessary for the listed cancer indications, including breast cancer, non-small cell lung cancer, prostate cancer, gastric cancer, head and neck cancer, ovarian cancer, small cell lung cancer, and soft tissue sarcoma. Breast cancer requires the disease-status criteria stated in the policy, and continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. All other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 19, 2026Medium impact
YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)
Aetna considers Nd:YAG laser capsulotomy medically necessary after cataract extraction in members with visually significant clouding of the posterior capsule, and considers Nd:YAG laser peripheral iridotomy medically necessary for acute primary angle closure, primary angle-closure glaucoma, plateau iris syndrome, aqueous misdirection, and before intraocular lens insertion into the anterior chamber to avoid post-operative iris bombe or pupil block. Capsulotomy performed within 6 months of cataract surgery is subject to medical necessity review, and it is considered experimental, investigational, or unproven if none of the stated criteria is met. Nd:YAG laser vitreolysis for vitreous floaters, posterior hyaloidotomy for pre-macular hemorrhage, goniopuncture for failed trabeculectomy, and peripheral iridotomy to prevent pigment dispersion glaucoma are considered experimental, investigational, or unproven, as are many non-ophthalmological uses such as basal cell carcinoma, benign prostatic hyperplasia, onychomycosis and snoring.
Aetna · Identified Aug 18, 2026Medium impact
Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)
Aetna covers transanal endoscopic microsurgery (TEM) for benign rectal tumors (adenomas), low-risk Tis and T1 rectal carcinoma, and small rectal carcinoids less than 2 cm in diameter. Aetna considers TEM experimental, investigational, or unproven for other indications, including advanced rectal cancer, anorectal melanoma, benign rectal strictures, rectal prolapse and diverticula, rectal schwannoma, and recto-urinary and recto-vesical fistulas. The covered CPT code is 0184T, and the policy lists the ICD-10 codes that are covered if selection criteria are met and the codes not covered for the listed indications.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Interim PET Scanning in Oncology to Detect Early Response During Treatment
Interim FDG-PET scans to determine response to tyrosine kinase inhibitor treatment in individuals with gastrointestinal stromal tumors are considered medically necessary. Interim FDG-PET to assess response during treatment for advanced (stages IIB to 4) Hodgkin lymphoma is also considered medically necessary. PET scans to determine early response to treatment in gastrointestinal stromal tumors on palliative or adjuvant therapy, and in all other cancers, are considered investigational.
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 C49.A9?

There are 7 tracked policy changes affecting code C49.A9, including updates from 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 C49.A9?

Payers that have issued tracked updates for code C49.A9 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C49.A9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C49.A9. 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 C49.A9?

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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Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2026-10-21)

Docetaxel (CPB 0956, reviewed 2026-10-05)

YAG Laser in Ophthalmology and Other Selected Indications (CPB 0354, reviewed 2026-05-21)

Transanal Endoscopic Microsurgery (CPB 0747, reviewed 2025-11-26)

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

Interim PET Scanning in Oncology to Detect Early Response During Treatment

Hematopoietic Cell Transplantation for Solid Tumors of Childhood

What insurance policy changes affect code C49.A9?

Which payers have updated policy for code C49.A9?

How do I get notified when code C49.A9 policy changes?

Why do payers change policies for code C49.A9?