C84.A0 Insurance Policy Changes

ICD-10 C84.A0 is officially defined as "Cutaneous T-cell lymphoma, unspecified, unspecified site." code C84.A0 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.A0 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 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 Aug 19, 2026Medium impact
Brachytherapy (CPB 0371, reviewed 2026-05-20)
Aetna considers brachytherapy medically necessary for breast, esophageal, eye tumors, genitourinary cancers other than bladder, gynecologic, head and neck, respiratory and digestive tract, and soft tissue sarcoma indications when the EviCore Healthcare Radiation Therapy Clinical Guidelines criteria are met. It also considers brachytherapy medically necessary for skin cancer where surgical resection and photon or electron beam techniques are contraindicated, and for stenotic obstruction after lung transplantation refractory to other treatments. Brachytherapy for bladder cancer, bone metastases, brain tumors, leukemia, lymphoma, multiple myeloma, pancreatic cancer, keloids, palmoplantar pustulosis, spinal tumors and spinal metastases, and subfoveal choroidal neovascularization secondary to age-related macular degeneration is considered experimental, investigational or unproven, and electronic brachytherapy is considered experimental, investigational or unproven for breast cancer and all other indications.
Aetna · Identified Aug 18, 2026Medium impact
Tisagenlecleucel (Kymriah) (CPB 0920, reviewed 2026-02-24)
Aetna Clinical Policy Bulletin 0920 sets the commercial medical coverage criteria for tisagenlecleucel (Kymriah), a CD19-directed autologous CAR T-cell therapy. Aetna considers it medically necessary for relapsed or refractory B-cell precursor acute lymphoblastic leukemia in members under 26 years of age, for specified relapsed or refractory adult B-cell lymphomas (including DLBCL and follicular lymphoma) under stated criteria, for ALK-positive large B-cell lymphoma if CD19-positive, and for histologic (Richter) transformation to DLBCL under stated criteria. Aetna considers all other indications experimental, investigational, or unproven, including adult ALL, AML, CLL, Hodgkin lymphoma, plasma cell disorders, and repeat administration of the therapy.
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 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.
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.A0?

There are 8 tracked policy changes affecting code C84.A0, 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.A0?

Payers that have issued tracked updates for code C84.A0 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C84.A0 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C84.A0. 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.A0?

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

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

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

Brachytherapy (CPB 0371, reviewed 2026-05-20)

Tisagenlecleucel (Kymriah) (CPB 0920, reviewed 2026-02-24)

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

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

Extracorporeal Photopheresis

What insurance policy changes affect code C84.A0?

Which payers have updated policy for code C84.A0?

How do I get notified when code C84.A0 policy changes?

Why do payers change policies for code C84.A0?