C83.59 Insurance Policy Changes

ICD-10 C83.59 is officially defined as "Lymphoblastic (diffuse) lymphoma, extranodal and solid organ sites." code C83.59 is referenced in 4 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C83.59 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 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.
Aetna · Identified Aug 13, 2026Medium impact
Pegaspargase (Oncaspar) (CPB 0959, reviewed 2025-12-03)
Aetna considers pegaspargase (Oncaspar) medically necessary for commercial medical plan members when it is used with multi-agent chemotherapy to treat acute lymphoblastic leukemia or lymphoblastic lymphoma, or extranodal natural killer/T-cell lymphoma or aggressive NK-cell leukemia. Continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. All other indications, the combined anti-PD-1 antibody, anlotinib and pegaspargase regimen with radiotherapy for NK/T-cell lymphoma, and the therapeutic drug monitoring protocol for preventing hypersensitivity reactions are considered experimental, investigational, or unproven. Medicare criteria are covered separately under Medicare Part B criteria.
Aetna · Identified Aug 12, 2026Medium impact
Asparaginase Erwinia Chrysanthemi (Recombinant)-rywn (Rylaze) (CPB 0864, reviewed 2025-12-02)
Aetna covers Rylaze (asparaginase erwinia chrysanthemi (recombinant)-rywn) for commercial medical plans when it is used for acute lymphoblastic leukemia (ALL) or lymphoblastic lymphoma (LBL) in members 1 month or older who have developed hypersensitivity to E. coli-derived asparaginase, and the drug is used together with multi-agent chemotherapy. It is also medically necessary for extranodal NK/T-cell lymphoma (ENKL) or aggressive NK-cell leukemia (ANKL) when the member previously received and developed hypersensitivity to an E. coli-derived asparaginase and the drug is used with multi-agent chemotherapy. Continuation of therapy is medically necessary for an indication listed in the policy when there is no evidence of unacceptable toxicity or disease progression, and all other indications are considered experimental, investigational, or unproven.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C83.59?

There are 4 tracked policy changes affecting code C83.59, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C83.59?

Payers that have issued tracked updates for code C83.59 include: Aetna.

How do I get notified when code C83.59 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C83.59. 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 C83.59?

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

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

Pegaspargase (Oncaspar) (CPB 0959, reviewed 2025-12-03)

Asparaginase Erwinia Chrysanthemi (Recombinant)-rywn (Rylaze) (CPB 0864, reviewed 2025-12-02)

What insurance policy changes affect code C83.59?

Which payers have updated policy for code C83.59?

How do I get notified when code C83.59 policy changes?

Why do payers change policies for code C83.59?