C86.30 Insurance Policy Changes

ICD-10 C86.30 is officially defined as "Subcutaneous panniculitis-like T-cell lymphoma not having achieved remission." code C86.30 is referenced in 4 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 C86.30 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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 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
Pralatrexate (CPB 0740, reviewed 2025-09-11)
Aetna considers pralatrexate (Folotyn or generic pralatrexate) 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 for each indication are met. Continuation of therapy is considered medically necessary for these indications when there is no evidence of unacceptable toxicity or disease progression while on the current regimen. Aetna considers pralatrexate experimental, investigational, or unproven for all other indications, including esophagogastric cancer, head and neck squamous cell cancer, multiple myeloma, non-small cell lung carcinoma, pleural mesothelioma and solid tumors.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas
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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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C86.30?

There are 4 tracked policy changes affecting code C86.30, 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 C86.30?

Payers that have issued tracked updates for code C86.30 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C86.30 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C86.30. 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 C86.30?

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

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

Pralatrexate (CPB 0740, reviewed 2025-09-11)

Hematopoietic Cell Transplantation for Non-Hodgkin Lymphomas

What insurance policy changes affect code C86.30?

Which payers have updated policy for code C86.30?

How do I get notified when code C86.30 policy changes?

Why do payers change policies for code C86.30?