ICD-10 C83.398 is officially defined as "Diffuse large B-cell lymphoma of other extranodal and solid organ sites." code C83.398 is referenced in 9 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C83.398 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.
Independence Blue Cross Medicare Advantage policy MA08.108g expands coverage for Polivy (HCPCS J9309): it adds the GemOx-R regimen for Burkitt lymphoma, refines CAR T-cell sequencing criteria, and adds ICD-10 codes as medically necessary. The policy became effective November 2, 2026, so it is already in effect, and it covers Polivy under the Part B medical benefit only, not the Part D pharmacy benefit.
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 commercial policy 08.01.59g expands coverage for Polivy (HCPCS J9309): it adds the GemOx-R regimen for Burkitt lymphoma and refines CAR T-cell sequencing criteria, and it adds a long list of ICD-10 codes as medically necessary. The policy became effective November 2, 2026, so it is already in effect, and the notice's excerpt does not include the full criteria for the new mantle cell lymphoma heading.
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.
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 considers non-myeloablative hematopoietic cell transplantation (mini-allograft) medically necessary for members with acute lymphoblastic leukemia, acute myelogenous leukemia, aplastic anemia, chronic lymphocytic leukemia, chronic myelogenous leukemia, Hodgkin's disease, multiple myeloma, myelofibrosis, myelodysplasia, neuroblastoma, non-Hodgkin's lymphoma, sickle cell anemia or thalassemia major, where conventional allogeneic transplant is an established alternative. Aetna considers it experimental, investigational, or unproven for acquired angioedema, autoimmune diseases, breast cancer, essential thrombocythemia and polycythemia vera, melanoma, ovarian cancer, renal cancer and testicular cancer. For members with the listed diseases who are eligible for conventional ASCT, mini-allograft is a technical variation of an established procedure; for members who are ineligible for conventional ASCT, including those with other malignancies, mini-allograft is still considered investigational.
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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