What insurance policy changes affect code C54.2?

There are 3 tracked policy changes affecting code C54.2, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C54.2?

Payers that have issued tracked updates for code C54.2 include: Aetna.

How do I get notified when code C54.2 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C54.2. 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 C54.2?

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.

PAYER POLICY CHANGES

C54.2 Insurance Policy Changes

ICD-10 C54.2 is officially defined as "Malignant neoplasm of myometrium." code C54.2 is referenced in 3 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C54.2 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 13, 2026Medium impact
Temsirolimus (Torisel) (CPB 0873, reviewed 2026-10-08)
Aetna's Clinical Policy Bulletin 0873 considers temsirolimus (Torisel or generic temsirolimus) medically necessary as a single agent for subsequent treatment of locally advanced, recurrent or metastatic endometrial carcinoma, for relapsed or refractory mantle cell lymphoma, and for advanced renal cell carcinoma, along with specified soft tissue sarcoma and uterine sarcoma subtypes. The covered sarcoma uses are locally advanced unresectable or metastatic perivascular epithelioid cell tumor (PEComa), recurrent angiomyolipoma or lymphangioleiomyomatosis, and rhabdomyosarcoma (maximum 12 cycles, given with cyclophosphamide and vinorelbine). Aetna considers temsirolimus experimental, investigational or unproven for all other indications, including acute lymphoblastic leukemia, breast cancer, colorectal cancer, melanoma, multiple myeloma and prostate cancer, and for endovascular treatment of below-the-knee atherosclerotic lesions.
Aetna · Identified Aug 18, 2026Medium impact
Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)
Aetna considers temsirolimus (Torisel or generic temsirolimus) medically necessary as a single agent for subsequent treatment of locally advanced, recurrent, or metastatic endometrial carcinoma, for relapsed or refractory mantle cell lymphoma, and for advanced renal cell carcinoma. It also considers it medically necessary for specified soft tissue sarcoma subtypes, for rhabdomyosarcoma (maximum 12 cycles, with cyclophosphamide and vinorelbine), and for subsequent treatment of advanced, recurrent/metastatic, or inoperable PEComa in uterine sarcoma. Aetna considers all other indications experimental, investigational, or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
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.

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Temsirolimus (Torisel) (CPB 0873, reviewed 2026-10-08)

Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)

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

What insurance policy changes affect code C54.2?

Which payers have updated policy for code C54.2?

How do I get notified when code C54.2 policy changes?

Why do payers change policies for code C54.2?