C74.00 Insurance Policy Changes

ICD-10 C74.00 is officially defined as "Malignant neoplasm of cortex of unspecified adrenal gland." code C74.00 is referenced in 12 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 C74.00 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 10, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)
Aetna considers radiofrequency ablation (RFA) medically necessary for indications that include colorectal cancer liver metastases, colorectal cancer lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), malignant lung masses in persons who are not candidates for surgical intervention, solitary hepatocellular carcinoma of 5 cm or less or multinodular early-stage HCC in members who are ineligible for or decline surgical resection or transplantation, renal cell carcinoma up to 4 cm in high-risk surgical candidates or in persons with renal insufficiency or a solitary kidney, and osteoid osteoma in individuals who remain symptomatic despite NSAIDs. Aetna considers RFA experimental, investigational, or unproven for combined RFA with transarterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, combined RFA and vertebral cement augmentation for spinal metastases, endoscopic ultrasound-guided RFA for aldosterone-producing adenomas, and all other indications, including curative treatment of primary or metastatic malignant neoplasms in persons able to tolerate surgical resection, biliary obstructions or strictures, renal cysts, renal angiomyolipomas, Brunner's gland hyperplasia, and unresectable localized recurrent thyroid cancers without distant metastases.
Aetna · Identified Oct 6, 2026Medium impact
Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (CPB 0634, reviewed 2026-09-25)
Aetna considers non-myeloablative hematopoietic cell transplantation (mini-allograft) medically necessary for members with acute lymphoblastic leukemia, acute myelogenous leukemia, aplastic anemia, chronic lymphocytic leukemia, chronic myelogenous leukemia, Hodgkin's disease, multiple myeloma, myelofibrosis, myelodysplasia, neuroblastoma, non-Hodgkin's lymphoma, sickle cell anemia or thalassemia major, where conventional allogeneic transplant is an established alternative. Aetna considers it experimental, investigational, or unproven for acquired angioedema, autoimmune diseases, breast cancer, essential thrombocythemia and polycythemia vera, melanoma, ovarian cancer, renal cancer and testicular cancer. For members with the listed diseases who are eligible for conventional ASCT, mini-allograft is a technical variation of an established procedure; for members who are ineligible for conventional ASCT, including those with other malignancies, mini-allograft is still considered investigational.
Aetna · Identified Aug 18, 2026Medium impact
Tisagenlecleucel (Kymriah) (CPB 0920, reviewed 2026-02-24)
Aetna Clinical Policy Bulletin 0920 sets the commercial medical coverage criteria for tisagenlecleucel (Kymriah), a CD19-directed autologous CAR T-cell therapy. Aetna considers it medically necessary for relapsed or refractory B-cell precursor acute lymphoblastic leukemia in members under 26 years of age, for specified relapsed or refractory adult B-cell lymphomas (including DLBCL and follicular lymphoma) under stated criteria, for ALK-positive large B-cell lymphoma if CD19-positive, and for histologic (Richter) transformation to DLBCL under stated criteria. Aetna considers all other indications experimental, investigational, or unproven, including adult ALL, AML, CLL, Hodgkin lymphoma, plasma cell disorders, and repeat administration of the therapy.
Aetna · Identified Aug 17, 2026Medium impact
Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (CPB 0496, reviewed 2026-08-06)
Aetna considers autologous hematopoietic cell transplantation medically necessary as consolidation therapy for high-risk neuroblastoma when the member meets the transplanting institution's protocol selection criteria. Without a protocol, it is considered medically necessary when the stated criteria are met, including tandem autologous transplants for the common high-risk group and a single autologous transplant for the special high-risk groups. Autologous transplant is not medically necessary for members with progressive disease during or at the end of induction therapy. Autologous transplant is also addressed for chemosensitive relapsed or refractory neuroblastoma, relapsed or progressive chemosensitive Ewing's sarcoma family of tumors that is not widely metastatic, primitive neuroectodermal tumors including medulloblastoma and pineoblastoma, ependymoma in members ineligible for radiotherapy, extraocular retinoblastoma, and progressive or relapsed chemosensitive Wilms' tumor. Allogeneic hematopoietic cell transplantation for ependymoma, Ewing's sarcoma family of tumors, neuroblastoma, primitive neuroectodermal tumors, retinoblastoma and Wilms' tumor, adoptive cellular immunotherapy following transplantation for childhood solid tumors, and autologous transplantation for soft tissue sarcomas are considered experimental, investigational, or unproven.
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 16, 2026Medium impact
Naxitamab-gqgk (Danyelza) (CPB 0984, reviewed 2026-01-13)
Aetna considers naxitamab-gqgk (Danyelza) medically necessary for commercial members only for high-risk neuroblastoma that meets the initial approval criteria, and precertification is required of all Aetna participating providers and members in applicable plan designs. Initial approval criteria are age 1 year or older, relapsed or refractory disease in the bone or bone marrow, a partial or minor response, stable disease, or progressive disease with prior therapy, and use in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF). Aetna considers all other indications experimental, investigational, or unproven. Continuation of therapy is considered medically necessary for reauthorization of a listed indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen. The drug carries a black box warning for serious infusion-related reactions and neurotoxicity.
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
Dinutuximab (Unituxin) (CPB 0895, reviewed 2025-10-23)
Aetna considers dinutuximab (Unituxin) medically necessary for high-risk neuroblastoma in members less than 21 years of age, in combination with sargramostim, aldesleukin and 13-cis-retinoic acid (isotretinoin), once the member has achieved at least a partial response to prior first-line multiagent, multimodality therapy. The policy also covers chemoimmunotherapy with temozolomide, irinotecan and sargramostim in specified high-risk disease settings, and continuation therapy for up to a maximum of 5 cycles. Aetna considers dinutuximab experimental, investigational or unproven for all other indications, including Ewing sarcoma, Ewing-like sarcoma, glioblastoma multiforme, lung cancer, osteosarcoma and triple-negative breast cancer.
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.
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.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Estrogen Hormone Testing: Estradiol and Estrone
Measurement of estrogen hormones is considered medically necessary to evaluate ovarian function in females with symptoms of hypoestrogenism or hyperestrogenism, to diagnose hyperestrogenism in symptomatic males, to monitor hormone replacement therapy in postmenopausal females, and to monitor antiestrogen therapy. Measurement of estrogen hormones is considered not medically necessary when performed for screening purposes in asymptomatic patients. The covered tests are total estradiol (CPT 82670), fractionated estrogens (CPT 82671), total estrogens (CPT 82672), estrone (CPT 82679), and free estradiol by direct measurement, such as equilibrium dialysis (CPT 82681).

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C74.00?

There are 12 tracked policy changes affecting code C74.00, 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 C74.00?

Payers that have issued tracked updates for code C74.00 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C74.00 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C74.00. 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 C74.00?

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

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-10-05)

Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (CPB 0634, reviewed 2026-09-25)

Tisagenlecleucel (Kymriah) (CPB 0920, reviewed 2026-02-24)

Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (CPB 0496, reviewed 2026-08-06)

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

Naxitamab-gqgk (Danyelza) (CPB 0984, reviewed 2026-01-13)

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

Dinutuximab (Unituxin) (CPB 0895, reviewed 2025-10-23)

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

Hematopoietic Cell Transplantation for Solid Tumors of Childhood

Estrogen Hormone Testing: Estradiol and Estrone

What insurance policy changes affect code C74.00?

Which payers have updated policy for code C74.00?

How do I get notified when code C74.00 policy changes?

Why do payers change policies for code C74.00?