C69.30 Insurance Policy Changes

ICD-10 C69.30 is officially defined as "Malignant neoplasm of unspecified choroid." code C69.30 is referenced in 10 tracked payer policy changes from Aetna, Blue Cross & Blue Shield of Mississippi, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C69.30 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
Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-10-05)
Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina and without associated vitreal or sub-retinal seeds at the time of thermotherapy, and for small (2 to 3 mm) choroidal melanomas located posterior in the globe. Aetna considers transpupillary thermotherapy experimental, investigational, or unproven for all other indications, including central serous chorioretinopathy, choroidal neovascularization associated with age-related macular degeneration, circumscribed choroidal hemangioma, retinopathy of prematurity and polypoidal choroidal vasculopathy. The stated reason is the lack of prospective, controlled clinical studies supporting its effectiveness for these indications.
Aetna · Identified Aug 19, 2026Medium impact
Brachytherapy (CPB 0371, reviewed 2026-05-20)
Aetna considers brachytherapy medically necessary for breast, esophageal, eye tumors, genitourinary cancers other than bladder, gynecologic, head and neck, respiratory and digestive tract, and soft tissue sarcoma indications when the EviCore Healthcare Radiation Therapy Clinical Guidelines criteria are met. It also considers brachytherapy medically necessary for skin cancer where surgical resection and photon or electron beam techniques are contraindicated, and for stenotic obstruction after lung transplantation refractory to other treatments. Brachytherapy for bladder cancer, bone metastases, brain tumors, leukemia, lymphoma, multiple myeloma, pancreatic cancer, keloids, palmoplantar pustulosis, spinal tumors and spinal metastases, and subfoveal choroidal neovascularization secondary to age-related macular degeneration is considered experimental, investigational or unproven, and electronic brachytherapy is considered experimental, investigational or unproven for breast cancer and all other indications.
Aetna · Identified Aug 18, 2026Medium impact
Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)
Aetna considers transpupillary thermotherapy medically necessary for retinoblastoma involving less than 50% of the retina, without associated vitreal or sub-retinal seeds at the time of thermotherapy, and for small (2 to 3 mm) choroidal melanomas located posterior in the globe. Aetna considers transpupillary thermotherapy experimental, investigational, or unproven for all other indications, including central serous chorioretinopathy, choroidal metastases, choroidal neovascularization associated with age-related macular degeneration, polypoidal choroidal vasculopathy, and retinopathy of prematurity.
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 17, 2026Medium impact
Tebentafusp-tebn (Kimmtrak) (CPB 1005, reviewed 2026-04-09)
Aetna considers tebentafusp-tebn (Kimmtrak) medically necessary for uveal melanoma only when the member is HLA-A*02:01-positive and the disease is unresectable or metastatic. Continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression while on the current regimen. Aetna considers all other indications experimental, investigational, or unproven, and precertification is required for all Aetna participating providers and members in applicable plan designs.
Aetna · Identified Aug 16, 2026Medium impact
Lifileucel (Amtagvi) (CPB 1056, reviewed 2026-04-08)
Aetna Clinical Policy Bulletin 1056 covers lifileucel (Amtagvi) for commercial medical plans, and Medicare criteria are in a separate document. Aetna considers it medically necessary as a single dose for unresectable or metastatic melanoma in members 18 years and older who have already received a PD-1 blocking antibody and, if BRAF V600 mutation positive, a BRAF inhibitor with or without a MEK inhibitor. The member must not have received Amtagvi before, must not have uveal or ocular melanoma or uncontrolled brain metastases, must not have had an organ allograft (except kidney transplant) or prior cell transfer, must have adequate and stable kidney, pulmonary and cardiac function, an ECOG performance status of 0 or 1, and no clinically significant active infection. Aetna considers all other indications experimental, investigational, or unproven.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Gene Expression Profiling for Uveal Melanoma
Gene expression profiling for uveal melanoma with DecisionDx-UM is medically necessary for individuals with primary, localized uveal melanoma. Gene expression profiling for uveal melanoma that does not meet that criterion is investigational. To date, the U.S. Food and Drug Administration has chosen not to require any regulatory review of this test.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions
Charged-particle irradiation with proton or helium ion beams may be considered medically necessary for primary therapy of uveal tract melanoma meeting the listed size and metastasis criteria, for postoperative therapy after biopsy or partial resection of skull-base chordoma, low-grade chondrosarcoma or cervical spine lesions with residual localized tumor, and for pediatric central nervous system tumors. It may also be considered medically necessary where photon-based radiotherapy cannot meet normal tissue dose-volume constraints, including curative treatment of primary or benign solid pediatric non-CNS tumors such as Ewing sarcoma, nonmetastatic primary non-small cell lung cancer, and head and neck cancers. Clinically localized prostate cancer and non-curative treatment of these pediatric tumors and non-small cell lung cancer are considered investigational.
Independence Blue Cross · Identified Jun 19, 2026Low impact
MA08.143b, Tebentafusp-tebn (Kimmtrak®)
This is a reissue with no substantive changes to MA08.143b covering tebentafusp-tebn (Kimmtrak®) for HLA-A*02:01-positive uveal melanoma. The policy was reissued on 11/26/2025 as part of the annual review process. The active HCPCS code is J9274 (replacing deprecated codes C9095 and J9999). No workflow changes are required.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C69.30?

There are 10 tracked policy changes affecting code C69.30, including updates from Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C69.30?

Payers that have issued tracked updates for code C69.30 include: Aetna, Blue Cross & Blue Shield of Mississippi, Independence Blue Cross.

How do I get notified when code C69.30 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C69.30. 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 C69.30?

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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Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-10-05)

Brachytherapy (CPB 0371, reviewed 2026-05-20)

Transpupillary Thermal Therapy (CPB 0490, reviewed 2026-08-03)

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

Tebentafusp-tebn (Kimmtrak) (CPB 1005, reviewed 2026-04-09)

Lifileucel (Amtagvi) (CPB 1056, reviewed 2026-04-08)

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

Gene Expression Profiling for Uveal Melanoma

Charged-Particle (Proton or Helium Ion) Radiotherapy for Neoplastic Conditions

MA08.143b, Tebentafusp-tebn (Kimmtrak®)

What insurance policy changes affect code C69.30?

Which payers have updated policy for code C69.30?

How do I get notified when code C69.30 policy changes?

Why do payers change policies for code C69.30?