C52 Insurance Policy Changes

ICD-10 C52 is officially defined as "Malignant neoplasm of vagina." code C52 is referenced in 9 tracked payer policy changes from Blue Cross Blue Shield of North Dakota and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C52 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Blue Cross Blue Shield of North Dakota · Identified Jun 19, 2026High impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota revised many Commercial prior authorization drug policies, with revisions effective April 14, 2026, including oncology drugs such as Adcetris, Keytruda IV, Keytruda SQ, Opdivo IV, Opdivo SQ, Darzalex IV and Trodelvy. The same notice lists Commercial post service claim edit policy revisions effective March 1, 2026 for Aranesp, Epoetin alfa and Mircera, and Commercial medical drug coding updates effective April 1, 2026 with new, removed and changed HCPCS codes.
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 18, 2026Medium impact
Tisotumab Vedotin-tftv (Tivdak) (CPB 0998, reviewed 2026-01-13)
Aetna's Clinical Policy Bulletin 0998 covers tisotumab vedotin-tftv (Tivdak) for commercial medical plans, and Medicare criteria are in a separate Medicare Part B policy. Precertification is required of Aetna participating providers and members in applicable plan designs. Aetna considers Tivdak medically necessary for recurrent or metastatic cervical cancer with disease progression on or after chemotherapy, as a single agent or in combination with pembrolizumab when no prior immune-oncology therapy was received and the tumor is PD-L1 positive, and for subsequent treatment of recurrent or metastatic vaginal cancer as a single agent. Aetna considers all other indications experimental, investigational, or unproven. Continuation of therapy is considered medically necessary for members requesting reauthorization for a listed indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
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 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
Docetaxel (CPB 0956, reviewed 2025-12-04)
Aetna considers docetaxel (Beizray, Docivyx, Taxotere or generic docetaxel) medically necessary for the cancers listed in the policy, including breast cancer, non-small cell lung cancer, prostate cancer, gastric and esophageal cancers, head and neck cancer, bladder cancer, soft tissue sarcoma, uterine neoplasms and others, and considers continuation medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Aetna considers all other indications 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.
Aetna · Identified Aug 13, 2026Medium impact
Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)
Aetna considers albumin-bound paclitaxel (Abraxane or generic albumin-bound paclitaxel) medically necessary for the cancers listed in its initial approval criteria, including Kaposi sarcoma, breast cancer, cutaneous melanoma, endometrial carcinoma, ovarian, fallopian tube and primary peritoneal cancer, biliary tract cancers, non-small cell lung cancer, pancreatic adenocarcinoma, small bowel adenocarcinoma, uveal melanoma, ampullary adenocarcinoma, cervical cancer, bladder cancer and vaginal cancer, when each cancer's stated criteria are met. All other indications are considered experimental, investigational, or unproven, including small cell lung cancer, prostate cancer, soft-tissue sarcoma and gastric cancer. Continuation of therapy is medically necessary for an approved indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
Aetna · Identified Aug 12, 2026Medium impact
Cemiplimab-rwlc (Libtayo) (CPB 0942, reviewed 2026-06-12)
Aetna's Clinical Policy Bulletin 0942 sets the commercial coverage criteria for cemiplimab-rwlc (Libtayo). Aetna considers Libtayo medically necessary for cutaneous squamous cell carcinoma, basal cell carcinoma, non-small cell lung cancer, and the vulvar, cervical, vaginal, anal, small bowel, colon, appendiceal and rectal cancers listed in the policy when the stated criteria are met. Aetna considers all other indications experimental, investigational, or unproven, including hepatocellular carcinoma, Merkel cell carcinoma, penile cancer, Marjolin ulcer and xeroderma pigmentosum.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C52?

There are 9 tracked policy changes affecting code C52, including updates from Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C52?

Payers that have issued tracked updates for code C52 include: Blue Cross Blue Shield of North Dakota, Aetna.

How do I get notified when code C52 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C52. 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 C52?

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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Pharmacy Policy Updates

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

Tisotumab Vedotin-tftv (Tivdak) (CPB 0998, reviewed 2026-01-13)

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

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

Docetaxel (CPB 0956, reviewed 2025-12-04)

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

Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)

Cemiplimab-rwlc (Libtayo) (CPB 0942, reviewed 2026-06-12)

What insurance policy changes affect code C52?

Which payers have updated policy for code C52?

How do I get notified when code C52 policy changes?

Why do payers change policies for code C52?