C79.49 Insurance Policy Changes

ICD-10 C79.49 is officially defined as "Secondary malignant neoplasm of other parts of nervous system." code C79.49 is referenced in 13 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C79.49 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective May 15, 2026Medium impact
Magnetic Resonance Spectroscopy (MRS) 6.01.03
Effective May 15, 2026, Excellus BCBS policy 6.01.03 considers magnetic resonance spectroscopy (MRS) medically appropriate when conventional MRI or CT provides limited information and one of six indications applies, including distinguishing recurrent brain tumor from radiation necrosis as an alternative to PET, evidence or suspicion of primary or secondary neoplasm, grading of primary glial neoplasm, evidence or suspicion of brain infection, and seizures, especially temporal lobe epilepsy. The 01/22/26 update added a statement that MRS for the spine is not medically necessary, and MRS is not medically necessary for all spine uses. MRS is investigational for all other indications.
Aetna · Identified Oct 27, 2026Medium impact
Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2026-10-21)
Aetna Clinical Policy Bulletin 0731 (last review 10/21/2026) states that convection-enhanced delivery of drugs into brain parenchyma and low-intensity MR-guided focused ultrasound mediated disruption of the blood-brain barrier for drug delivery are experimental, investigational, or unproven because their safety and effectiveness have not been established. The policy lists CPT 0947T and several ICD-10 codes, including those for malignant neoplasm of brain, Alzheimer's disease, and epilepsy, as not covered for the indications listed in the bulletin.
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 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 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
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
Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2025-11-26)
Aetna considers convection-enhanced delivery of drugs into the brain parenchyma experimental, investigational, or unproven. Aetna also considers low-intensity MR-guided focused ultrasound (MRgFUS) mediated disruption of the blood-brain barrier for enhanced drug delivery into the brain experimental, because the safety and effectiveness of these approaches have not been established. CPT code 0947T for MRgFUS stereotactic blood-brain barrier disruption is not covered for the indications listed, and ICD-10 codes for brain malignancies, Alzheimer's disease, epilepsy and seizures are listed as not covered.
Aetna · Identified Aug 15, 2026Medium impact
Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-07-29)
Aetna considers radiofrequency ablation (RFA) medically necessary for several tumor indications, including colorectal cancer liver metastases, colorectal lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), and malignant lung masses in persons who are not candidates for surgical intervention. Solitary hepatocellular carcinoma of 5 cm or less is covered in members who are ineligible for or decline surgical resection or transplantation, and renal cell carcinoma up to 4 cm is covered in high-risk surgical candidates, persons with renal insufficiency, or persons with a solitary kidney. The policy lists curative RFA of malignant neoplasms in persons who are able to tolerate surgical resection, combined RFA with trans-arterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, and combined RFA with vertebral cement augmentation for spinal metastases as experimental, investigational, or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)
Aetna considers CT perfusion studies of the brain medically necessary for evaluating acute stroke (less than 24 hours), including hemorrhagic stroke, subdural hemorrhage and transient ischemic attacks, for following up cerebral ischemia or infarction, for planning therapy for cervical or intracranial arterial occlusive disease, for identifying cerebral hyperperfusion after revascularization, and for evaluating the vascular status of solid tumors when MRI is degraded by susceptibility artifact. Aetna considers MRI perfusion studies medically necessary for diagnosing and following mass lesions such as glioma, for assessing acute stroke penumbra, and for assessing the hemodynamic significance of cervical or intracranial vascular stenosis and the efficacy of revascularization. Aetna considers CT perfusion experimental, investigational or unproven for indications including confirmation of brain death, differentiation of lung cancer from benign lesions, evaluation of head trauma and evaluation of cerebral vasospasm, and considers MRI perfusion unproven for indications including evaluation of traumatic brain injury, evaluation of persistent pain and prognostication of obstructive sleep apnea.
Aetna · Identified Aug 14, 2026Medium impact
Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)
Magnetic resonance spectroscopy (MRS) is considered medically necessary for specific indications in this policy, including assessing prognosis in hypoxic ischemic encephalopathy, distinguishing low grade from high grade gliomas, and distinguishing recurrent brain tumor from radiation-induced tumor necrosis. MRS is considered experimental, investigational, or unproven for all other indications listed, including breast cancer, prostate cancer, epilepsy, dementia and movement disorders, and traumatic brain injury. CPT 76390 is covered for the listed indications, and CPT codes 0609T, 0610T, 0611T and 0612T are not covered for the indications listed. The policy was last reviewed 03/26/2026.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Intensity-Modulated Radiotherapy (IMRT): Central Nervous System Tumors
IMRT may be considered medically necessary for individuals with malignant or benign brain tumors when the tumor is proximate to organs at risk (brain stem, spinal cord, cochlea, and eye structures) and 3-dimensional conformal radiotherapy planning cannot meet dose-volume constraints for normal tissue tolerance. Hippocampal-avoiding IMRT may be considered medically necessary for individuals with brain tumor metastases outside a 5-mm margin around either hippocampus and expected survival of 4 months or more. IMRT is considered investigational for tumors of the central nervous system for all other indications.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C79.49?

There are 13 tracked policy changes affecting code C79.49, including updates from Excellus BlueCross BlueShield, 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 C79.49?

Payers that have issued tracked updates for code C79.49 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C79.49 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C79.49. 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 C79.49?

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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Magnetic Resonance Spectroscopy (MRS) 6.01.03

Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2026-10-21)

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

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

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

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

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

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

Selected Techniques for Delivery of Drugs to the Brain (CPB 0731, reviewed 2025-11-26)

Radiofrequency Tumor Ablation (CPB 0492, reviewed 2026-07-29)

Cerebral Perfusion Studies (CPB 0663, reviewed 2026-04-14)

Magnetic Resonance Spectroscopy (MRS) (CPB 0202, reviewed 2026-03-26)

Intensity-Modulated Radiotherapy (IMRT): Central Nervous System Tumors

What insurance policy changes affect code C79.49?

Which payers have updated policy for code C79.49?

How do I get notified when code C79.49 policy changes?

Why do payers change policies for code C79.49?