C83.00 Insurance Policy Changes

ICD-10 C83.00 is officially defined as "Small cell B-cell lymphoma, unspecified site." code C83.00 is referenced in 16 tracked payer policy changes from Independence Blue Cross, Blue Cross Blue Shield of North Dakota, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C83.00 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Nov 2, 2026Medium impact
MA08.139e, Loncastuximab tesirine-lpyl (Zynlonta®)
Independence Blue Cross Medicare Advantage policy MA08.139e adds Waldenstrom macroglobulinemia and lymphoplasmacytic lymphoma as a medically necessary use of Zynlonta (HCPCS J9359) for patients who have had a covalent BTK inhibitor or cannot take one, and adds a list of ICD-10 codes to that coverage. The policy became effective November 2, 2026, so it is already in effect, and it covers Zynlonta only under the Part B medical benefit, not the Part D pharmacy benefit.
Independence Blue Cross · Effective Nov 2, 2026Medium impact
MA08.062l, Carfilzomib (Kyprolis®)
Independence Blue Cross updated the carfilzomib (Kyprolis) coverage policy effective 11/02/2026 to reflect current FDA labeling and NCCN guidelines. Medical necessity criteria for multiple myeloma were revised to add new combination regimens for transplant-deferred patients and relapsed/progressive disease, and coverage was expanded to include Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma with new ICD-10 diagnosis codes.
Independence Blue Cross · Effective Nov 2, 2026Medium impact
08.00.59e, Loncastuximab tesirine-lpyl (Zynlonta®)
Independence Blue Cross added Waldenstrom macroglobulinemia and lymphoplasmacytic lymphoma as a medically necessary use of Zynlonta (HCPCS J9359) for patients who have had a covalent BTK inhibitor or cannot take one, and it added a long list of ICD-10 codes to that coverage. The policy became effective November 2, 2026, so it is already in effect as of the analysis date, and it applies to IBX commercial plans.
Independence Blue Cross · Effective Nov 2, 2026Medium impact
08.01.05n, Carfilzomib (Kyprolis®)
Independence Blue Cross updated its carfilzomib (Kyprolis) medical policy effective 11/02/2026 to align with FDA labeling and NCCN compendia. Medical necessity criteria for multiple myeloma were revised to add new combination regimens (including dexamethasone with belantamab mafodotin-blmf for relapsed/progressive disease), and new ICD-10 diagnosis codes were added for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma and related lymphomas to expand covered indications.
Blue Cross Blue Shield of North Dakota · Effective Mar 17, 2026Medium impact
Pharmacy Policies Available Online
Commercial prior authorization medical drug policies have revisions effective March 17, 2026, with many policies adding the Appendix A NQTL Factor Checklist, showing the number of days allowed for authorization durations, and replacing 'coverage' with 'prior authorization validity' in the initial and renewal criteria. Clinical updates include Eylea HD for macular edema following retinal vein occlusion, Breyanzi for relapsed or refractory marginal zone lymphoma, and new appendiceal neoplasm and cancer indications with ICD-10 codes D37.3 and Z85.038. Commercial post service claim edit policies for Trogarzo have revisions effective Feb. 1, 2026.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02
Excellus medical policy 7.02.02 sets when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered medically appropriate. It applies when the candidate meets the transplanting institution's selection criteria, the multidisciplinary team evaluates the individual and recommends treatment, and the individual is treated for one of the listed indications. The listed indications include acute and chronic leukemias, non-Hodgkin lymphoma, myelodysplastic diseases at intermediate or high risk, sickle cell anemia under stated criteria, transfusion-dependent thalassemia, bone marrow failure syndromes, severe combined immunodeficiency, hemophagocytic disorders, several storage and leukodystrophy disorders, and certain skeletal and metabolic bone disorders. Allo-HSCT is considered investigational for all other indications. The February 19, 2026 revision simplified the criteria to the indication level, removed the investigational indications list and added HCPCS code S2142.
Blue Cross Blue Shield of North Dakota · Effective Feb 10, 2026Medium impact
Pharmacy Policy Updates
Commercial prior authorization medical drug policies have revisions effective Feb. 10, 2026, including new indications such as Epkinly in combination with rituximab and lenalidomide for relapsed or refractory follicular lymphoma, Gazyva for active lupus nephritis, Darzalex SQ for high-risk smoldering multiple myeloma, and Bevacizumab for respiratory papillomatosis. Commercial post service claim edit policies for Botox, Dysport, Daxxify, Myobloc, Xeomin, Asparlas, and Besponsa have revisions effective Jan. 1, 2026, with multiple sclerosis coverage moving from G35 to G35.A through G35.D. Vyepti now covers chronic migraine with ICD-10 codes G43.E01, G43.E09, G43.E11, and G43.E19, and the Infugem policy is being retired because the manufacturer discontinued the product.
Aetna · Identified Oct 24, 2026Medium impact
Epcoritamab-bysp (Epkinly) (CPB 1034, reviewed 2026-10-16)
Aetna's Clinical Policy Bulletin 1034 (reviewed 2026-10-16) establishes coverage criteria for epcoritamab-bysp (Epkinly), a bispecific antibody for treating relapsed or refractory B-cell lymphomas. The policy requires precertification for all Aetna participating providers and members, specifies approved treatment combinations and dosing schedules, and limits certain regimens to a maximum of 12 cycles. All other indications remain experimental/investigational.
Aetna · Identified Oct 18, 2026Medium impact
Ibritumomab Tiuxetan (Zevalin) (CPB 0659, reviewed 2026-10-15)
Aetna's Clinical Policy Bulletin 0659 covers ibritumomab tiuxetan (Zevalin) for commercial medical plans. Aetna considers it medically necessary for relapsed or refractory, low-grade or follicular B-cell non-Hodgkin lymphoma, and for previously untreated follicular non-Hodgkin lymphoma in members who have achieved a partial or complete response to first-line chemotherapy. Aetna considers all other indications experimental, investigational or unproven, and considers a repeat course of treatment not medically necessary.
Aetna · Identified Oct 3, 2026Medium impact
Lisocabtagene Maraleucel (Breyanzi) (CPB 0986, reviewed 2026-09-14)
Aetna's Clinical Policy Bulletin 0986 covers one dose of lisocabtagene maraleucel (Breyanzi) for commercial members 18 or older with specified B-cell lymphomas and chronic lymphocytic leukemia or small lymphocytic lymphoma, each under listed prior-treatment criteria, and for relapsed or refractory pediatric primary mediastinal large B-cell lymphoma after at least two chemoimmunotherapy regimens. Members with primary central nervous system lymphoma, a previous CD19-directed CAR T-cell therapy, an ECOG performance status of 3 or higher, or several listed active or unstable conditions are not eligible. Repeat administration and use for solid tumors are considered experimental, investigational, or unproven.
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 16, 2026Medium impact
Lisocabtagene Maraleucel (Breyanzi) (CPB 0986, reviewed 2026-03-11)
Aetna Clinical Policy Bulletin 0986 covers lisocabtagene maraleucel (Breyanzi) for commercial medical plans, and Medicare criteria are in a separate document. Aetna considers Breyanzi medically necessary as one dose for adult B-cell lymphomas after at least two lines of systemic therapy, or after first-line chemoimmunotherapy with relapsed or refractory disease in specified subtypes. It is also considered medically necessary for relapsed or refractory mantle cell lymphoma after a covalent Bruton tyrosine kinase inhibitor, relapsed or refractory ALK-positive large B-cell lymphoma if CD19-positive, relapsed or refractory CLL or SLL after a covalent Bruton tyrosine kinase inhibitor and BCL-2 inhibitor regimens, Richter transformation to DLBCL, and relapsed or refractory pediatric primary mediastinal large B-cell lymphoma under age 18. Members with primary central nervous system lymphoma, a previous treatment with Breyanzi or another CD19-directed CAR T-cell therapy, an ECOG performance status of 3 or greater, inadequate and unstable kidney, liver, pulmonary or cardiac function, active hepatitis B or C or other uncontrolled infection, active graft versus host disease, or an active inflammatory disorder are not eligible. Repeat administration and use for solid tumors are considered 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.
Aetna · Identified Aug 13, 2026Medium impact
Plerixafor (CPB 0779, reviewed 2026-02-13)
Aetna's policy covers plerixafor (Mozobil or generic plerixafor) for hematopoietic stem cell mobilization when it is given after a granulocyte-colony stimulating factor such as filgrastim, after chemo-mobilization, or as part of a gene therapy protocol, and when it is not used beyond 4 consecutive days or after stem cell harvest or apheresis is complete. Continuation of therapy is considered medically necessary for members who meet the initial selection criteria. Aetna considers plerixafor experimental, investigational or unproven for all other indications, including the conditions listed in the policy such as acute leukemias, sickle cell disease, WHIM syndrome and neutropenia treatment.
Aetna · Identified Aug 13, 2026Medium impact
Elotuzumab (Empliciti) (CPB 0899, reviewed 2026-03-02)
Aetna Clinical Policy Bulletin 0899 covers elotuzumab (Empliciti) for commercial medical plans and requires precertification for all Aetna participating providers and members in applicable plan designs. Aetna considers elotuzumab medically necessary for previously treated multiple myeloma when it is used with lenalidomide and dexamethasone, with bortezomib and dexamethasone, or with pomalidomide and dexamethasone in members who have received at least two prior therapies, including an immunomodulatory agent and a proteasome inhibitor. The same combinations are considered medically necessary for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease, and plasma cell-related monoclonal gammopathy of renal significance, and all other indications, including newly diagnosed multiple myeloma and smoldering multiple myeloma, are considered experimental, investigational, or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C83.00?

There are 16 tracked policy changes affecting code C83.00, including updates from Independence Blue Cross, Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C83.00?

Payers that have issued tracked updates for code C83.00 include: Independence Blue Cross, Blue Cross Blue Shield of North Dakota, Excellus BlueCross BlueShield, Aetna.

How do I get notified when code C83.00 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C83.00. 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 C83.00?

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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MA08.139e, Loncastuximab tesirine-lpyl (Zynlonta®)

MA08.062l, Carfilzomib (Kyprolis®)

08.00.59e, Loncastuximab tesirine-lpyl (Zynlonta®)

08.01.05n, Carfilzomib (Kyprolis®)

Pharmacy Policies Available Online

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02

Pharmacy Policy Updates

Epcoritamab-bysp (Epkinly) (CPB 1034, reviewed 2026-10-16)

Ibritumomab Tiuxetan (Zevalin) (CPB 0659, reviewed 2026-10-15)

Lisocabtagene Maraleucel (Breyanzi) (CPB 0986, reviewed 2026-09-14)

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

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

Lisocabtagene Maraleucel (Breyanzi) (CPB 0986, reviewed 2026-03-11)

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

Plerixafor (CPB 0779, reviewed 2026-02-13)

Elotuzumab (Empliciti) (CPB 0899, reviewed 2026-03-02)

What insurance policy changes affect code C83.00?

Which payers have updated policy for code C83.00?

How do I get notified when code C83.00 policy changes?

Why do payers change policies for code C83.00?