C82.9A Insurance Policy Changes

ICD-10 C82.9A is officially defined as "Follicular lymphoma, unspecified, in remission." code C82.9A is referenced in 7 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 C82.9A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 5, 2026Medium impact
Tisagenlecleucel (Kymriah) (CPB 0920, reviewed 2026-09-11)
Aetna covers tisagenlecleucel (Kymriah) for commercial medical plans. Precertification of tisagenlecleucel is required of all Aetna participating providers and members in applicable plan designs. Covered indications are relapsed or refractory B-cell precursor acute lymphoblastic leukemia in members less than 26 years of age, relapsed or refractory B-cell lymphomas in members 18 years of age or older, relapsed or refractory ALK-positive large B-cell lymphoma if CD19-positive in members 18 years of age or older, and histologic (Richter) transformation to DLBCL in members 18 years of age or older when the stated criteria are met. Aetna considers tisagenlecleucel experimental, investigational or unproven for adults 26 years of age or older with acute lymphoblastic leukemia, acute myeloid leukemia, chronic lymphocytic leukemia, Hodgkin lymphoma, plasma cell disorders, primary central nervous system lymphoma, solid tumors and T-cell leukemia/lymphoma, and it considers repeat administration experimental and investigational.
Aetna · Identified Sep 30, 2026Medium impact
Polatuzumab Vedotin-piiq (Polivy) (CPB 0955, reviewed 2026-09-17)
Aetna's criteria for polatuzumab vedotin-piiq (Polivy) apply to commercial medical plans, and Medicare criteria are in a separate Part B document. Precertification is required for all Aetna participating providers and members in applicable plan designs. Aetna considers Polivy medically necessary for up to 6 cycles for HIV-related B-cell lymphomas, diffuse large B-cell lymphoma, high-grade B-cell lymphomas, histologic transformation of indolent lymphomas, B-cell post-transplant lymphoproliferative disorders, mantle cell lymphoma and Burkitt lymphoma when the listed criteria are met. Continuation is considered medically necessary for up to 6 months (maximum of 6 cycles total) when there is no unacceptable toxicity or disease progression, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Sep 29, 2026Medium impact
Brentuximab Vedotin (Adcetris) (CPB 0823, reviewed 2026-09-24)
Aetna considers brentuximab vedotin (Adcetris) medically necessary for commercial medical plans when the request meets one of the listed uses. Listed uses include classic Hodgkin lymphoma as a single agent or in named combinations, relapsed or refractory DLBCL, HGBL and histologic transformation of indolent lymphoma, pediatric primary mediastinal large B-cell lymphoma with nivolumab or pembrolizumab, several CD30-positive T-cell lymphomas and primary cutaneous lymphomas. Reauthorization is considered medically necessary for a listed indication when there is no evidence of unacceptable toxicity or disease progression, and all other indications are considered experimental, investigational, or unproven.
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
Tafasitamab-cxix (Monjuvi) (CPB 0979, reviewed 2025-11-04)
Aetna considers tafasitamab-cxix (Monjuvi) medically necessary for commercial medical plans for relapsed or refractory follicular lymphoma when used with lenalidomide and rituximab for up to a maximum of 12 cycles. For other B-cell lymphomas, it is medically necessary in combination with lenalidomide for up to 12 cycles when the member has HIV-related B-cell lymphoma, histologic transformation of indolent lymphoma to DLBCL without eligibility for an autologous stem cell transplant, monomorphic post-transplant lymphoproliferative disorder (B-cell type), DLBCL, or high-grade B-cell lymphoma. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Polatuzumab Vedotin-piiq (Polivy) (CPB 0955, reviewed 2025-03-13)
Aetna's clinical policy covers polatuzumab vedotin-piiq (Polivy) for commercial medical plans when the criteria for initial approval are met. Those criteria cover HIV-related B-cell lymphomas, diffuse large B-cell lymphoma, high-grade B-cell lymphomas, histologic transformation of indolent lymphomas, B-cell post-transplant lymphoproliferative disorders, mantle cell lymphoma and Burkitt lymphoma, with treatment approved for up to 6 cycles. Aetna considers Polivy experimental, investigational or unproven for all other indications.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Erythropoiesis-Stimulating Agents
Epogen (epoetin alfa), Procrit (epoetin alfa), and Retacrit (epoetin alfa-epbx) are considered medically necessary for anemia related to zidovudine therapy in HIV-infected individuals, anemia in non-myeloid malignancies caused by concomitantly administered chemotherapy, anemia in individuals scheduled for elective, noncardiac, nonvascular surgery to reduce the need for allogeneic blood transfusions, and anemia associated with chronic kidney disease. Aranesp (darbepoetin alfa) is considered medically necessary for anemia associated with chronic kidney disease, including individuals on dialysis and not on dialysis, and for anemia in non-myeloid malignancies caused by concomitantly administered chemotherapy. The 09/09/2025 revision updated the indications descriptions and added that services related to delivery or administration of a medication determined to be not medically necessary are also considered not medically necessary.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C82.9A?

There are 7 tracked policy changes affecting code C82.9A, 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 C82.9A?

Payers that have issued tracked updates for code C82.9A include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C82.9A policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C82.9A. 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 C82.9A?

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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Tisagenlecleucel (Kymriah) (CPB 0920, reviewed 2026-09-11)

Polatuzumab Vedotin-piiq (Polivy) (CPB 0955, reviewed 2026-09-17)

Brentuximab Vedotin (Adcetris) (CPB 0823, reviewed 2026-09-24)

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

Tafasitamab-cxix (Monjuvi) (CPB 0979, reviewed 2025-11-04)

Polatuzumab Vedotin-piiq (Polivy) (CPB 0955, reviewed 2025-03-13)

Erythropoiesis-Stimulating Agents

What insurance policy changes affect code C82.9A?

Which payers have updated policy for code C82.9A?

How do I get notified when code C82.9A policy changes?

Why do payers change policies for code C82.9A?