ICD-10 C79.89 is officially defined as "Secondary malignant neoplasm of other specified sites." code C79.89 is referenced in 7 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C79.89 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 has updated multiple pharmacy prior authorization policies for specialty medications, with new requirements effective October 1, 2025 for Datopotamab deruxtecan-dlnk (Datroway) and revised policies for various oncology drugs effective November 1, 2025. These changes affect prior authorization criteria, step therapy requirements, and billing codes for high-cost specialty medications.
Blue Cross Blue Shield of North Dakota revised many Commercial prior authorization drug policies, with revisions effective April 14, 2026, including oncology drugs such as Adcetris, Keytruda IV, Keytruda SQ, Opdivo IV, Opdivo SQ, Darzalex IV and Trodelvy. The same notice lists Commercial post service claim edit policy revisions effective March 1, 2026 for Aranesp, Epoetin alfa and Mircera, and Commercial medical drug coding updates effective April 1, 2026 with new, removed and changed HCPCS codes.
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 policy 2.02.60 considers germline genetic testing for hereditary cancer medically appropriate in listed circumstances, including when a blood relative has a known pathogenic or likely pathogenic variant, when a pathogenic or likely pathogenic variant is found on tumor genomic testing, when results aid systemic therapy or surgical decisions, and when individuals meet specific criteria for breast, ovarian, pancreatic, prostate, colorectal, Cowden syndrome, Li-Fraumeni syndrome, hereditary diffuse gastric cancer or familial medullary thyroid carcinoma. Multigene panel testing is considered medically appropriate when an individual meets Policy Statement I, except Policy Statements I.A, I.D and I.G.9. The current effective date is April 16, 2026, and the annual update kept the policy intent unchanged.
Aetna considers excimer and pulsed dye laser treatment medically necessary for persons with mild-to-moderate localized plaque psoriasis affecting 10% or less of body area who have failed to adequately respond to 3 or more months of topical treatments, including at least 3 of the listed agents. No more than 13 laser treatments per course and 3 courses per year are generally considered medically necessary, and additional courses are not considered medically necessary if the person fails to respond to an initial course, as documented by a reduction in PASI score or other objective response measurement. The policy also covers laser hair removal for recurrent pilonidal cyst, laser treatment for acne keloidalis nuchae and penile intraepithelial neoplasia, and Nd:YAG laser for hidradenitis suppurativa. Combined pulsed dye laser and UVB for localized plaque psoriasis, and excimer or pulsed dye laser for psoriasis other than plaque psoriasis, are considered experimental, investigational or unproven, as is laser treatment for the other listed skin conditions. Laser treatment for acne scarring, keratosis pilaris, pearly penile papules and rhinophyma is considered cosmetic.
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.
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.
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