C78.7 Insurance Policy Changes

ICD-10 C78.7 is officially defined as "Secondary malignant neoplasm of liver and intrahepatic bile duct." code C78.7 is referenced in 15 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, and 3 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C78.7 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 · Effective Jun 10, 2026Medium impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota revised many Commercial prior authorization medical drug policies, with revisions effective June 10, 2026. Most changes delineate initial and renewal authorization durations and state the number of days allowed, add the NQTL Factor Checklist appendix, and add new or expanded indications for oncology and other drugs, while the Aliqopa policy is being retired after the manufacturer withdrew the product. Separately, Commercial post service claim edit policies had revisions effective May 1, 2026.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Radioembolization (TARE) for Hepatic Tumors 7.01.69
Excellus BlueCross BlueShield policy 7.01.69 considers transarterial radioembolization (TARE) with yttrium-90 microspheres medically necessary for unresectable or medically inoperable hepatocellular carcinoma, as a bridge to transplant for patients who meet liver transplant criteria and are waiting, for intrahepatic cholangiocarcinoma, and for unresectable metastatic hepatic tumors that meet the listed criteria (neuroendocrine tumors, colorectal, breast, and melanoma). A second TARE is considered medically necessary for a new, progressive tumor after a satisfactory response to an initial TARE, and a third TARE is considered not medically necessary. The version effective February 19, 2026 is an annual review with policy intent unchanged, following a 02/20/25 revision that added statements for primary intrahepatic cholangiocarcinoma and for metastatic hepatic tumors related to cutaneous melanoma.
Excellus BlueCross BlueShield · Effective Nov 16, 2025Medium impact
Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12
Excellus BlueCross BlueShield stereotactic radiosurgery and stereotactic body radiation therapy medical policy 6.01.12 has a current effective date of November 16, 2025. Its October 16, 2025 annual review removed life expectancy criteria from the policy criteria. SRS is considered medically appropriate for specified benign, brain and neurologic indications, SBRT is considered medically appropriate for specified extracranial cancers and oligometastatic disease, and SBRT is considered not medically necessary for indications including extrahepatic bile duct cancer, gallbladder cancer and chronic pain.
Aetna · Identified Oct 3, 2026Medium impact
Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-09-18)
Aetna considers percutaneous ethanol injection (PEI) medically necessary for hepatocellular carcinoma (HCC) without extra-hepatic spread and for neuroendocrine cancers involving the liver. Chemoembolization is medically necessary for neuroendocrine cancers involving the liver, unresectable primary HCC, liver-only metastasis from uveal melanoma, and pre-operative hepatic artery chemoembolization followed by orthotopic liver transplantation for HCC. Intra-hepatic microspheres (TheraSphere, SIR-Spheres, also known as trans-arterial radio-embolization) are medically necessary for neuroendocrine cancers involving the liver, unresectable primary HCC, unresectable liver tumors from primary colorectal cancer, unresectable and chemo-refractory intra-hepatic cholangiocarcinoma with liver metastases only, and pre-operative use as a bridge to orthotopic liver transplantation for HCC. Intra-hepatic chemotherapy is medically necessary for members with liver metastases from colorectal cancer. Many other uses are listed as experimental, investigational or unproven, including chemoembolization for palliative treatment of liver metastases from non-neuroendocrine primaries, PEI for liver neoplasms when the criteria above are not met, combined electrochemotherapy and immunotherapy for HCC, the TriNav Infusion System, the TheraBionic P1 System, and degradable starch microsphere chemoembolization for HCC.
Aetna · Identified Aug 17, 2026Medium impact
Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-04-16)
Aetna considers percutaneous ethanol injection, chemoembolization, intra-hepatic chemotherapy and intra-hepatic microspheres (also called TARE) medically necessary for listed liver indications. These include unresectable primary hepatocellular carcinoma (HCC), neuroendocrine tumors involving the liver, liver-only metastasis from uveal melanoma, unresectable liver tumors from colorectal cancer, and pre-operative use before liver transplantation for HCC. The policy considers many other uses experimental, investigational or unproven, including chemoembolization for liver metastases from non-neuroendocrine primaries, combined radiofrequency ablation and percutaneous ethanol injection for HCC, drug-eluting beads for liver metastases from colorectal cancer, the TriNav Infusion System and the TheraBionic P1 System.
Aetna · Identified Aug 17, 2026Medium impact
Strontium Chloride Sr-89 (CPB 0361, reviewed 2026-01-09)
Aetna considers strontium chloride Sr-89 medically necessary for the relief of bone pain when the member has a cancer diagnosis and bone metastases. Aetna considers all other indications experimental, investigational, or unproven, including use in members with cancer not involving the bone. Continued therapy on reauthorization is medically necessary when there is no evidence of unacceptable toxicity on the current regimen and the member is experiencing clinical benefit.
Aetna · Identified Aug 16, 2026Medium impact
Irreversible Electroporation (NanoKnife) (CPB 0828, reviewed 2026-03-03)
This is an older Aetna clinical policy bulletin (CPB 0828) on irreversible electroporation (IRE), including the NanoKnife system for tissue ablation. It was last reviewed 03/03/2026, and its original effective date is 06/15/2012. Aetna considers IRE experimental, investigational or unproven for all indications, including the listed indications such as hepatocellular carcinoma, pancreatic cancer, prostate cancer, renal masses, lung nodules and breast cancer, because the peer-reviewed literature has insufficient evidence.
Aetna · Identified Aug 16, 2026Medium impact
Sipuleucel-T (Provenge) (CPB 0802, reviewed 2025-12-22)
Aetna's Clinical Policy Bulletin 0802 covers sipuleucel-T (Provenge) for commercial medical plans, and Medicare criteria are in a separate policy. Aetna considers one course of sipuleucel-T, a total of 3 doses, medically necessary for metastatic castrate-resistant (hormone-refractory) prostate cancer in members who are asymptomatic or minimally symptomatic, have ECOG performance status 0 or 1, and do not have liver metastases, and therapy is limited to one course. Aetna considers all other indications experimental, investigational, or unproven, including prevention of prostate cancer, stage I to III prostate cancer, localized prostate cancer, and administration of more than 3 complete doses.
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
Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies
Transcatheter arterial chemoembolization of the liver may be considered medically necessary to treat unresectable hepatocellular cancer confined to the liver, as a bridge to transplant, to treat symptomatic liver metastases from neuroendocrine tumors that persist despite systemic therapy, and to treat liver-dominant metastatic uveal melanoma. It is considered investigational as neoadjuvant or adjuvant therapy for resectable hepatocellular cancer, as part of combination therapy with radiofrequency ablation, for unresectable intrahepatic cholangiocarcinoma, and for other liver metastases or hepatocellular cancer not meeting the criteria above. The policy history records a 09/12/2025 review with no changes.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus
Photodynamic therapy may be considered medically necessary for palliative treatment of obstructing esophageal cancer, palliative treatment of obstructing endobronchial lesions, early-stage non-small-cell lung cancer in individuals ineligible for surgery and radiotherapy, high-grade dysplasia in Barrett esophagus, and palliative treatment of unresectable cholangiocarcinoma when used with stenting. Other oncologic applications, including Barrett esophagus without high-grade dysplasia, are investigational. The policy history records a 09/12/2025 description update, with policy guidelines updated regarding focal therapy.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Radioembolization for Primary and Metastatic Tumors of the Liver
The policy considers yttrium-90 microsphere radioembolization medically necessary for primary hepatocellular carcinoma that is unresectable and limited to the liver, as a bridge to liver transplantation, and for primary intrahepatic cholangiocarcinoma in individuals with unresectable tumors. It also considers radioembolization medically necessary for hepatic metastases from neuroendocrine tumors with diffuse and symptomatic disease when systemic therapy has failed to control symptoms. It may be considered medically necessary for unresectable hepatic metastases from colorectal carcinoma, melanoma (ocular or cutaneous), or breast cancer that are both progressive and diffuse, in individuals with liver-dominant disease who are refractory to chemotherapy or are not candidates for chemotherapy or other systemic therapies. Radioembolization is investigational for all other hepatic metastases and for all other indications not described.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Radiofrequency Ablation of Primary or Metastatic Liver Tumors
Radiofrequency ablation of inoperable hepatocellular carcinoma may be considered medically necessary as a primary treatment when the tumor meets the Milan criteria (a single tumor of 5 cm or less, or up to 3 nodules under 3 cm), and as a bridge to liver transplant when the intent is to prevent further tumor growth and maintain candidacy for transplant. For inoperable hepatic metastases, it may be considered medically necessary when the metastases are of colorectal origin and meet the Milan criteria, or of neuroendocrine origin and systemic therapy has failed to control symptoms. Ablation of operable hepatocellular carcinoma, of more than three nodules or when not all tumor foci can be adequately treated, of hepatocellular carcinoma used to downstage for transplant, and of hepatic metastases from other cancers except colorectal or neuroendocrine tumors is considered investigational.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Microwave Tumor Ablation
This Blue Cross Blue Shield Association policy states that microwave ablation of primary or metastatic liver tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 5 cm or less or up to 3 nodules of 3 cm or less each. Microwave ablation of primary or metastatic lung tumors may be considered medically necessary when the tumor is unresectable due to lesion location and/or comorbid conditions and is a single tumor of 3 cm or less. Microwave ablation of more than a single lung tumor, and of primary or metastatic tumors other than liver or lung, is considered investigational.
Medical Mutual of Ohio · Identified Jun 20, 2026Medium impact
HEDIS Advanced Illness and Frailty Exclusion
Medical Mutual of Ohio has implemented HEDIS exclusion guidelines for advanced illness and frailty patients. Billing teams must use specific ICD-10 codes to exclude eligible patients (ages 66-80 with both conditions, or 81+ with frailty) from certain HEDIS quality measures like cancer screenings and diabetes management.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C78.7?

There are 15 tracked policy changes affecting code C78.7, including updates from Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C78.7?

Payers that have issued tracked updates for code C78.7 include: Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi, Medical Mutual of Ohio.

How do I get notified when code C78.7 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C78.7. 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 C78.7?

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

Radioembolization (TARE) for Hepatic Tumors 7.01.69

Stereotactic Radiosurgery and Stereotactic Body Radiation Therapy 6.01.12

Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-09-18)

Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-04-16)

Strontium Chloride Sr-89 (CPB 0361, reviewed 2026-01-09)

Irreversible Electroporation (NanoKnife) (CPB 0828, reviewed 2026-03-03)

Sipuleucel-T (Provenge) (CPB 0802, reviewed 2025-12-22)

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

Transcatheter Arterial Chemoembolization to Treat Primary or Metastatic Liver Malignancies

Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus

Radioembolization for Primary and Metastatic Tumors of the Liver

Radiofrequency Ablation of Primary or Metastatic Liver Tumors

Microwave Tumor Ablation

HEDIS Advanced Illness and Frailty Exclusion

What insurance policy changes affect code C78.7?

Which payers have updated policy for code C78.7?

How do I get notified when code C78.7 policy changes?

Why do payers change policies for code C78.7?