ICD-10 C86.10 is officially defined as "Hepatosplenic T-cell lymphoma not having achieved remission." code C86.10 is referenced in 7 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C86.10 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.
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 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'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 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 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.
8.01.20 on hematopoietic cell transplantation for non-Hodgkin lymphomas. Allogeneic transplant with a myeloablative conditioning regimen or autologous transplant may be considered medically necessary for aggressive B-cell subtypes (except mantle cell lymphoma) as salvage therapy, to achieve or consolidate complete remission in a chemosensitive relapse, or to consolidate a first complete remission in diffuse large B-cell lymphoma with a high or high-intermediate risk International Prognostic Index score. Tandem transplants and autologous or allogeneic transplants as initial therapy are considered investigational. A 07/16/2026 policy history entry changed 'patients' to 'individuals' in the description, policy statement and guidelines and removed ICD-9 codes from the code reference.
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