What insurance policy changes affect code C66.9?

There are 9 tracked policy changes affecting code C66.9, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C66.9?

Payers that have issued tracked updates for code C66.9 include: Aetna.

How do I get notified when code C66.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C66.9. 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 C66.9?

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

C66.9 Insurance Policy Changes

ICD-10 C66.9 is officially defined as "Malignant neoplasm of unspecified ureter." code C66.9 is referenced in 9 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 C66.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 19, 2026Medium impact
Mitomycin Pyelocalyceal Solution (Jelmyto) (CPB 0972, reviewed 2026-10-14)
Aetna's policy on Jelmyto (mitomycin pyelocalyceal solution) applies to commercial medical plans, and precertification is required. Aetna considers Jelmyto medically necessary for 6 doses of treatment of non-metastatic, low-grade, low-volume (5-15 mm) upper tract urothelial cancer when it is given by pyelocalyceal administration once weekly for the first six weeks. Continuation is covered for a maximum of 11 additional monthly doses after a complete response at 3 months, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Oct 16, 2026Medium impact
Enfortumab Vedotin-ejfv (Padcev) (CPB 0967, reviewed 2026-10-09)
Aetna covers enfortumab vedotin-ejfv (Padcev) for commercial medical plans, and precertification of Padcev is required for Aetna participating providers and members in applicable plan designs. Aetna considers Padcev medically necessary for urothelial carcinoma when criteria are met, including as a single agent used as subsequent therapy after platinum-containing chemotherapy and prior PD-1 or PD-L1 inhibitor treatment, or as subsequent therapy for members ineligible for cisplatin-containing chemotherapy, and in combination with pembrolizumab or pembrolizumab and berahyaluronidase alfa-pmph for stage II, recurrent, locally advanced, or metastatic urothelial carcinoma. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Oct 15, 2026Medium impact
Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)
Aetna considers avelumab (Bavencio) medically necessary for commercial plan members with Merkel cell carcinoma, renal cell carcinoma in combination with axitinib, urothelial carcinomas, gestational trophoblastic neoplasia, endometrial carcinoma, thymic carcinoma, extranodal NK/T-cell lymphoma, colorectal adenocarcinoma, and small bowel adenocarcinoma when the criteria for each indication are met. Precertification of avelumab is required for all Aetna participating providers and members in applicable plan designs, and members who have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy are not eligible. Aetna considers avelumab experimental, investigational, or unproven for all other indications, including breast cancer, non-small cell lung cancer, ovarian cancer, prostate cancer, and pancreatic cancer.
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 17, 2026Medium impact
Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)
Aetna's Clinical Policy Bulletin 0811 considers autologous or allogeneic hematopoietic stem cell transplant, both ablative and non-myeloablative, experimental, investigational, or unproven for the following adult solid tumors: bile duct (cholangiocarcinoma), breast, central nervous system tumors, cervix, colon, esophagus, fallopian tube, gallbladder, kidney, liver, lung, melanoma, nasopharynx, neuroendocrine tumors, pancreas, paranasal sinus, prostate, rectum, soft tissue sarcomas, stomach, thymus, thyroid, tumors of unknown primary origin, and uterus. Aetna considers autologous hematopoietic stem cell transplant medically necessary in young adults with primitive neuroectodermal tumors, medulloblastoma, and Ewing sarcoma family of tumors when criteria are met in CPB 0496.
Aetna · Identified Aug 16, 2026Medium impact
Mitomycin Pyelocalyceal Solution (Jelmyto) (CPB 0972, reviewed 2025-08-13)
Precertification from Aetna is required of participating providers and members in applicable commercial plan designs. Aetna considers mitomycin (Jelmyto) medically necessary for six doses of treatment of non-metastatic, low-grade, low volume (5-15 mm) upper tract urothelial cancer when the drug is given pyelocalyceally and administered once weekly for the first six weeks. Continuation therapy is considered medically necessary for a maximum of 11 additional monthly doses after a complete response at 3 months, and all other indications are considered experimental, investigational, or unproven. The recommended dose is 4 mg per mL via ureteral catheter or nephrostomy tube, not to exceed 15 mL (60 mg of mitomycin).
Aetna · Identified Aug 13, 2026Medium impact
Enfortumab Vedotin-ejfv (Padcev) (CPB 0967, reviewed 2026-04-24)
Aetna Clinical Policy Bulletin 0967 covers enfortumab vedotin-ejfv (Padcev) for commercial medical plans and requires precertification for all Aetna participating providers and members in applicable plan designs. Aetna considers Padcev medically necessary for urothelial carcinoma as a single agent when it is used as subsequent therapy after platinum-containing chemotherapy and a PD-1 or PD-L1 inhibitor, or as subsequent therapy for members who are ineligible for cisplatin-containing chemotherapy, in the listed bladder, upper genitourinary tract, and prostate settings, and in combination with pembrolizumab or pembrolizumab and berahyaluronidase alfa-pmph for stage II, recurrent, locally advanced, or metastatic urothelial carcinoma. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)
Aetna considers durvalumab (Imfinzi) medically necessary for commercial medical plans when the criteria for a listed indication are met, and considers all other indications experimental, investigational, or unproven. Precertification is required of all Aetna participating providers and members in applicable plan designs, and Aetna considers members not eligible for Imfinzi when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy. Continuation of therapy is medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen, up to 12 months total for unresectable stage II or III NSCLC and up to 24 months total for limited stage SCLC.
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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Mitomycin Pyelocalyceal Solution (Jelmyto) (CPB 0972, reviewed 2026-10-14)

Enfortumab Vedotin-ejfv (Padcev) (CPB 0967, reviewed 2026-10-09)

Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)

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

Hematopoietic Cell Transplantation for Solid Tumors in Adults (CPB 0811, reviewed 2025-12-03)

Mitomycin Pyelocalyceal Solution (Jelmyto) (CPB 0972, reviewed 2025-08-13)

Enfortumab Vedotin-ejfv (Padcev) (CPB 0967, reviewed 2026-04-24)

Durvalumab (Imfinzi) (CPB 0917, reviewed 2026-06-25)

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

What insurance policy changes affect code C66.9?

Which payers have updated policy for code C66.9?

How do I get notified when code C66.9 policy changes?

Why do payers change policies for code C66.9?