C84.69 Insurance Policy Changes

ICD-10 C84.69 is officially defined as "Anaplastic large cell lymphoma, ALK-positive, extranodal and solid organ sites." code C84.69 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 C84.69 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 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 14, 2026Medium impact
Breast Implant Removal (CPB 0142, reviewed 2026-03-19)
Aetna considers breast implant removal medically necessary for members who had cosmetic augmentation or breast reconstruction after a medically necessary mastectomy and who meet at least one listed criterion. The criteria include breast cancer in the implanted or contralateral breast where implant removal is necessary to excise the cancer, breast implant-associated anaplastic large cell lymphoma, implant extrusion through the skin, recurrent infections, Baker Class IV contracture associated with severe pain, severe contracture that interferes with mammography, intra- or extra-capsular rupture of silicone gel-filled implants, cutaneous hypersensitivity-like reactions that failed conventional treatments, and persistent pain, lumps, swelling or asymmetry in textured implants after the surgical incision has fully healed. Requests for removal for Baker Class III contracture that does not follow a medically necessary mastectomy, for a biopsy of a breast mass not proven to be cancerous, or for a mastectomy or lumpectomy that can be performed with the implant in place are subject to medical review. Aetna does not consider IgG testing in connection with silicone implants medically necessary, and it does not consider removal of silicone implants for autoimmune disease medically necessary unless a selection criterion is met.
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C84.69?

There are 4 tracked policy changes affecting code C84.69, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C84.69?

Payers that have issued tracked updates for code C84.69 include: Aetna.

How do I get notified when code C84.69 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C84.69. 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 C84.69?

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

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

Breast Implant Removal (CPB 0142, reviewed 2026-03-19)

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

What insurance policy changes affect code C84.69?

Which payers have updated policy for code C84.69?

How do I get notified when code C84.69 policy changes?

Why do payers change policies for code C84.69?