ICD-10 C91.62 is officially defined as "Prolymphocytic leukemia of T-cell type, in relapse." code C91.62 is referenced in 3 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 C91.62 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 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.
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.
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