C92.12 Insurance Policy Changes

ICD-10 C92.12 is officially defined as "Chronic myeloid leukemia, BCR/ABL-positive, in relapse." code C92.12 is referenced in 6 tracked payer policy changes from Excellus BlueCross BlueShield, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C92.12 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Excellus BlueCross BlueShield · Effective Mar 19, 2026Medium impact
JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms 2.02.53
Molecular testing for suspected myelofibrosis (MF) or essential thrombocythemia (ET) is medically necessary when the test is completed on blood or bone marrow, the patient presents with clinical, laboratory, or pathologic findings suggesting MF or ET, secondary causes have been evaluated, and a JAK2, MPL, or CALR mutation is tested for. Molecular testing for suspected polycythemia vera (PV) is medically necessary when the test is completed on blood or bone marrow, the patient presents with findings suggesting PV, evaluation for secondary causes has been completed, and the test is for JAK2 mutations. JAK2, MPL, and CALR testing is investigational in all other circumstances, including diagnosis of nonclassic myeloproliferative neoplasms and molecular phenotyping of patients with MPNs. Broad molecular panel testing is considered investigational.
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 Oct 1, 2026Medium impact
Donor Lymphocyte Infusion (CPB 0638, reviewed 2026-09-29)
Aetna considers donor lymphocyte infusion medically necessary for persons who have had a prior medically necessary allogeneic bone marrow or peripheral stem cell transplantation. Several uses are considered experimental, investigational, or unproven, including GCSF-stimulated donor lymphocyte infusions for relapsed disease, intrathecal donor lymphocyte infusion, modified donor lymphocytes, reduced-dose infusion for Epstein-Barr virus-related post-transplant lymphoproliferative disease, pre-transplant infusion of extracorporeal photochemotherapy-treated donor lymphocytes for solid organ transplant, and donor lymphocyte-derived natural killer cells for melanoma. The policy does not apply to FDA-approved chimeric antigen receptor therapy, which is addressed in CPB 0920 and CPB 0924.
Aetna · Identified Aug 14, 2026Medium impact
Donor Lymphocyte Infusion (CPB 0638, reviewed 2025-11-12)
Aetna considers donor lymphocyte infusion (DLI) medically necessary for persons who have had a prior, medically necessary allogeneic bone marrow or peripheral stem cell transplantation. Aetna considers these uses experimental, investigational, or unproven: GCSF-stimulated DLI for relapsed disease after allogeneic hematopoietic cell transplantation, intrathecal DLI, modified donor lymphocytes (such as depleted, expanded, T-cell depleted, CAR-modified or genetically modified cells), pre-transplant infusion of extracorporeal photochemotherapy-treated donor lymphocytes to prevent graft rejection after solid organ transplantation, reduced-dose DLI for Epstein-Barr virus-related post-transplant lymphoproliferative disease, and donor lymphocyte-derived natural killer cells for melanoma. The policy does not apply to FDA-approved CAR T therapy, which involves modification of autologous lymphocytes.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia
Allogeneic hematopoietic cell transplantation using a myeloablative conditioning regimen may be considered medically necessary as a treatment of chronic myeloid leukemia. Allogeneic hematopoietic cell transplantation using a reduced-intensity conditioning regimen may be considered medically necessary for individuals who meet clinical criteria for an allogeneic HCT but are not considered candidates for a myeloablative conditioning allogeneic HCT, and autologous HCT is investigational for chronic myeloid leukemia. The policy was reviewed 07/27/2026 with policy statements unchanged, and ICD-9 procedure and diagnosis codes were removed from the code reference.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia
BCR-ABL1 qualitative testing may be considered medically necessary for the diagnosis of chronic myeloid leukemia. Quantitative RT-PCR testing of BCR-ABL1 mRNA transcript levels may be considered medically necessary for monitoring treatment response and remission in CML and Philadelphia chromosome-positive ALL. Evaluation of ABL kinase domain single nucleotide variants for tyrosine kinase inhibitor resistance may be considered medically necessary when there is an inadequate initial response, any sign of loss of response, or, for CML, progression to the accelerated or blast phase.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C92.12?

There are 6 tracked policy changes affecting code C92.12, including updates from Excellus BlueCross BlueShield, 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 C92.12?

Payers that have issued tracked updates for code C92.12 include: Excellus BlueCross BlueShield, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C92.12 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C92.12. 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 C92.12?

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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JAK2, MPL, and CALR Testing for Myeloproliferative Neoplasms 2.02.53

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

Donor Lymphocyte Infusion (CPB 0638, reviewed 2026-09-29)

Donor Lymphocyte Infusion (CPB 0638, reviewed 2025-11-12)

Hematopoietic Cell Transplantation for Chronic Myeloid Leukemia

BCR-ABL1 Testing in Chronic Myelogenous Leukemia and Acute Lymphoblastic Leukemia

What insurance policy changes affect code C92.12?

Which payers have updated policy for code C92.12?

How do I get notified when code C92.12 policy changes?

Why do payers change policies for code C92.12?