C84.40 Insurance Policy Changes

ICD-10 C84.40 is officially defined as "Peripheral T-cell lymphoma, not elsewhere classified, unspecified site." code C84.40 is referenced in 8 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 C84.40 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 6, 2026Medium impact
Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (CPB 0634, reviewed 2026-09-25)
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.
Aetna · Identified Sep 30, 2026Medium impact
Pralatrexate (CPB 0740, reviewed 2026-09-10)
Aetna's clinical policy bulletin for pralatrexate (Folotyn or generic pralatrexate) considers it medically necessary for adult T-cell leukemia/lymphoma, breast implant-associated anaplastic large cell lymphoma, cutaneous anaplastic large cell lymphoma, extranodal NK/T-cell lymphoma, hepatosplenic T-cell lymphoma, mycosis fungoides or Sezary syndrome, peripheral T-cell lymphoma, and subcutaneous panniculitis-like T-cell lymphoma when the listed criteria are met. Most of these indications require use as a single agent, and several also set line-of-therapy or response requirements. Continuation is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression, and all other indications, including multiple myeloma, non-small cell lung carcinoma and solid tumors, 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 Sep 29, 2026Medium impact
Belinostat (Beleodaq) (CPB 0887, reviewed 2026-09-10)
Aetna considers belinostat (Beleodaq) medically necessary for commercial medical plans as a single agent for relapsed or refractory peripheral T-cell lymphoma or for palliative intent, for hepatosplenic T-cell lymphoma after two or more previous lines of chemotherapy, and for relapsed or refractory extranodal NK/T-cell lymphoma with an inadequate response or contraindication to asparaginase-based therapy. It is also considered medically necessary for subsequent therapy in adult T-cell leukemia/lymphoma and breast implant-associated anaplastic large cell lymphoma. Reauthorization is considered medically necessary for a listed indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen, and all other indications, including concomitant use with Folotyn, Istodax, Ninlaro or Zolinza, are considered experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Romidepsin (CPB 0865, reviewed 2026-04-17)
Aetna's Clinical Policy Bulletin 0865 covers romidepsin (Istodax or generic romidepsin) for commercial medical plans when it treats cutaneous T-cell lymphoma, including mycosis fungoides, Sézary syndrome, primary cutaneous anaplastic large cell lymphoma and subcutaneous panniculitis-like T-cell lymphoma, or peripheral T-cell lymphoma. 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, including acute myeloid leukemia, chronic lymphocytic leukemia, multiple myeloma and breast cancer, are considered experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Brentuximab Vedotin (Adcetris) (CPB 0823, reviewed 2026-02-24)
Aetna Clinical Policy Bulletin 0823 covers brentuximab vedotin (Adcetris) for commercial medical plans. For Medicare criteria, see Medicare Part B Criteria. Aetna considers the drug medically necessary for classical Hodgkin lymphoma, CD30-positive B-cell lymphomas, primary cutaneous lymphomas and listed CD30-positive T-cell lymphomas when the stated criteria are met, and considers all other indications experimental, investigational or unproven, including acute myeloid leukemia, mesothelioma, multiple myeloma, renal cell cancer and small cell lung cancer.
Aetna · Identified Aug 12, 2026Medium impact
Belinostat (Beleodaq) (CPB 0887, reviewed 2025-12-09)
Aetna considers belinostat (Beleodaq) medically necessary for commercial plans as a single agent in these cases: peripheral T-cell lymphoma that is relapsed or refractory or used for palliative intent, hepatosplenic T-cell lymphoma after two or more previous lines of chemotherapy, relapsed or refractory extranodal NK/T-cell lymphoma with an inadequate response or contraindication to asparaginase-based therapy, and adult T-cell leukemia/lymphoma or breast implant-associated anaplastic large cell lymphoma used for subsequent therapy. Aetna considers belinostat experimental, investigational, or unproven for all other indications, including B-cell lymphomas, Hodgkin lymphoma, and multiple myeloma, and for concomitant use with Folotyn (pralatrexate), Istodax (romidepsin), Ninlaro (ixazomib), or Zolinza (vorinostat). Continuation of belinostat is medically necessary for a listed indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Extracorporeal Photopheresis
Extracorporeal photopheresis may be considered medically necessary to treat cardiac allograft rejection that is recurrent or refractory to standard immunosuppressive drug treatment, and to treat acute or chronic graft-versus-host disease that is refractory to medical therapy. It may also be considered medically necessary for late-stage (III or IV) cutaneous T-cell lymphoma and for early-stage (I or II) cutaneous T-cell lymphoma that is progressive and refractory to established nonsystemic therapies. Other solid organ rejection uses, graft-versus-host disease that is previously untreated or responding to established therapies, early-stage cutaneous T-cell lymphoma that is untreated or responsive to established nonsystemic therapies, autoimmune diseases, and all other indications are considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C84.40?

There are 8 tracked policy changes affecting code C84.40, 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 C84.40?

Payers that have issued tracked updates for code C84.40 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C84.40 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C84.40. 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 C84.40?

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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Non-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (CPB 0634, reviewed 2026-09-25)

Pralatrexate (CPB 0740, reviewed 2026-09-10)

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

Belinostat (Beleodaq) (CPB 0887, reviewed 2026-09-10)

Romidepsin (CPB 0865, reviewed 2026-04-17)

Brentuximab Vedotin (Adcetris) (CPB 0823, reviewed 2026-02-24)

Belinostat (Beleodaq) (CPB 0887, reviewed 2025-12-09)

Extracorporeal Photopheresis

What insurance policy changes affect code C84.40?

Which payers have updated policy for code C84.40?

How do I get notified when code C84.40 policy changes?

Why do payers change policies for code C84.40?