C91.50 Insurance Policy Changes

ICD-10 C91.50 is officially defined as "Adult T-cell lymphoma/leukemia (HTLV-1-associated) not having achieved remission." code C91.50 is referenced in 14 tracked payer policy changes from Blue Cross Blue Shield of North Dakota and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C91.50 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 · Effective Jul 14, 2026High impact
Pharmacy Policy Updates
Blue Cross Blue Shield of North Dakota revised many Commercial prior authorization medical drug policies, with revisions effective July 14, 2026, including new or expanded indications for drugs such as Cosentyx, Darzalex SQ, Keytruda IV and Opdivo IV and changes to length of authorization durations. The same notice lists Commercial post service claim edit policy revisions effective June 1, 2026, and Commercial medical drug coding updates effective July 1, 2026 that add new HCPCS codes for denosumab biosimilars, Armlupeg, Starjemza, Eydenzelt and others and discontinue unclassified code J3590 for several of them.
Aetna · Identified Oct 6, 2026Medium impact
Marnetegragene Autotemcel (Kresladi) (CPB 1102)
Aetna's Clinical Policy Bulletin 1102 addresses marnetegragene autotemcel (Kresladi) for commercial medical plans, and it points to the Medicare Part B criteria for Medicare. Precertification is required of all Aetna participating providers and members in applicable plan designs, through National Medical Excellence at 877-212-8811. Unless the member's health plan has elected not to require it, gene and cellular therapies must be administered at an Aetna Institutes GCIT Network, and Aetna considers the one-time administration medically necessary when all listed LAD-I criteria are met.
Aetna · Identified Oct 3, 2026Medium impact
Interferons (CPB 0404, reviewed 2026-09-10)
Aetna's interferon policy covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, mycosis fungoides/Sezary syndrome and severe malignant osteopetrosis, and considers all other indications experimental, investigational, or unproven. Pegasys (peginterferon alfa-2a) and Besremi (ropeginterferon alfa-2b-njft) each have their own list of covered indications, and several Besremi indications are covered only when Pegasys is unavailable. Aetna considers continuation of therapy medically necessary for members who are experiencing benefit, as evidenced by disease stability or disease improvement, and the Biojector 2000 needle-free injection system is considered a medically necessary alternative to needles for members with exacerbating-remitting MS who cannot safely self-inject due to tremors and decreased coordination.
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 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
Mogamulizumab-kpkc (Poteligeo) (CPB 0940, reviewed 2026-04-28)
Aetna considers mogamulizumab-kpkc (Poteligeo) intravenous infusion medically necessary for adult T-cell leukemia/lymphoma (ATLL) when used as a single agent for subsequent therapy for chronic high risk, acute, or lymphoma subtypes, or in combination with CHOP if there is no intention to proceed to transplant. It is also medically necessary for mycosis fungoides (MF) or Sézary syndrome (SS). Continuation is medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen, and all other indications are considered experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Interferons (CPB 0404, reviewed 2026-06-09)
Aetna covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, severe malignant osteopetrosis, and mycosis fungoides/Sezary syndrome, and considers all other indications experimental, investigational, or unproven. Aetna covers peginterferon alfa-2a (Pegasys) for adult T-cell leukemia/lymphoma, chronic hepatitis B for up to a total of 48 weeks, chronic hepatitis C, chronic hepatitis E in liver transplant recipients who meet the ribavirin criteria, and several myeloproliferative, mastocytosis, and lymphoma indications. Ropeginterferon alfa-2b-njft (Besremi) is covered for polycythemia vera and for several other indications when peginterferon alfa-2a (Pegasys) is unavailable.
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.
Aetna · Identified Aug 12, 2026Medium impact
Bortezomib Products (CPB 0675, reviewed 2026-02-17)
Aetna Clinical Policy Bulletin 0675, last reviewed 02/17/2026, sets commercial medical coverage criteria for bortezomib (Velcade, Boruzu, or generic bortezomib). Aetna considers bortezomib medically necessary for acute lymphoblastic leukemia, adult T-cell leukemia/lymphoma as a single agent for subsequent therapy, Kaposi sarcoma as subsequent therapy, antibody mediated rejection of solid organ, relapsed or refractory follicular lymphoma, relapsed or refractory pediatric classic Hodgkin lymphoma, mantle cell lymphoma, multicentric Castleman disease as subsequent therapy, multiple myeloma, POEMS syndrome, plasma cell-related MIDD and MGRS, systemic light chain amyloidosis, and Waldenström macroglobulinemia/lymphoplasmacytic lymphoma, and considers all other indications experimental, investigational, or unproven, including acute myeloid leukemia, glioblastoma multiforme, and smoldering (asymptomatic) myeloma. Approvals may be subject to dosing limits, and for all indications dosing does not exceed 1.6 mg/m2 per dose or require more than 7 doses per 30-day period.
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
Bendamustine Products (CPB 0875, reviewed 2026-02-24)
Precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and generic bendamustine) is required of all Aetna participating providers and members in applicable commercial plan designs. Aetna considers bendamustine medically necessary for CLL or SLL without chromosome 17p deletion or TP53 mutation, and for listed B-cell lymphomas, T-cell lymphomas, multiple myeloma, POEMS syndrome, plasma cell-related MIDD and MGRS, classic Hodgkin lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, Waldenstrom macroglobulinemia, systemic light chain amyloidosis, autologous transplant conditioning, and cold agglutinin disease when the listed criteria are met. Aetna considers all other indications experimental, investigational, or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
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 C91.50?

There are 14 tracked policy changes affecting code C91.50, including updates from Blue Cross Blue Shield of North Dakota, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C91.50?

Payers that have issued tracked updates for code C91.50 include: Blue Cross Blue Shield of North Dakota, Aetna.

How do I get notified when code C91.50 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C91.50. 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 C91.50?

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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Pharmacy Policy Updates

Marnetegragene Autotemcel (Kresladi) (CPB 1102)

Interferons (CPB 0404, reviewed 2026-09-10)

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

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

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

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

Mogamulizumab-kpkc (Poteligeo) (CPB 0940, reviewed 2026-04-28)

Interferons (CPB 0404, reviewed 2026-06-09)

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

Bortezomib Products (CPB 0675, reviewed 2026-02-17)

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

Bendamustine Products (CPB 0875, reviewed 2026-02-24)

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

What insurance policy changes affect code C91.50?

Which payers have updated policy for code C91.50?

How do I get notified when code C91.50 policy changes?

Why do payers change policies for code C91.50?