C92.40 Insurance Policy Changes

ICD-10 C92.40 is officially defined as "Acute promyelocytic leukemia, not having achieved remission." code C92.40 is referenced in 7 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 C92.40 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 15, 2026Medium impact
Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)
Aetna considers avelumab (Bavencio) medically necessary for commercial plan members with Merkel cell carcinoma, renal cell carcinoma in combination with axitinib, urothelial carcinomas, gestational trophoblastic neoplasia, endometrial carcinoma, thymic carcinoma, extranodal NK/T-cell lymphoma, colorectal adenocarcinoma, and small bowel adenocarcinoma when the criteria for each indication are met. Precertification of avelumab is required for all Aetna participating providers and members in applicable plan designs, and members who have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy are not eligible. Aetna considers avelumab experimental, investigational, or unproven for all other indications, including breast cancer, non-small cell lung cancer, ovarian cancer, prostate cancer, and pancreatic cancer.
Aetna · Identified Oct 4, 2026Medium impact
Hematopoietic Cell Transplantation for Selected Leukemias (CPB 0640, reviewed 2026-09-11)
Aetna's clinical policy bulletin CPB 0640 (reviewed 2026-09-11, first detected here 2026-10-04, so this is historical material) sets when stem cell transplant is covered for acute lymphocytic, myeloid and other leukemias. It covers allogeneic transplants for most of these leukemias when the transplant center's criteria are met, but it lists autologous transplant for ALL, CMML and JMML, tandem transplants for ALL, repeat transplants for AML that has not gone into remission, hepcidin testing and micro-transplantation as experimental. The notice gives no new effective date and does not say what changed in this review, so confirm the current bulletin with Aetna before acting on it.
Aetna · Identified Aug 15, 2026Medium impact
Gemtuzumab Ozogamicin (Mylotarg) (CPB 0922, reviewed 2026-05-28)
Aetna's policy for gemtuzumab ozogamicin (Mylotarg) covers the drug for commercial medical plans when it treats acute myeloid leukemia (AML) or acute promyelocytic leukemia (APL) and the tumor is CD33-positive, as confirmed by testing or analysis that identifies the CD33 antigen. Continuation of therapy is covered for members with an indication listed under Criteria for Initial Approval when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Acute lymphoblastic leukemia, Hodgkin lymphoma, non-Hodgkin lymphoma and solid tumors are listed as experimental, investigational or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Palivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)
Aetna considers palivizumab (Synagis) medically necessary for commercial medical plans for up to 5 doses per RSV season to prevent serious lower respiratory tract disease caused by RSV, when a member has a qualifying diagnosis such as prematurity, chronic lung disease of prematurity, hemodynamically significant congenital heart disease, cystic fibrosis or profound immunocompromise and the associated criteria are met. Palivizumab is excluded for members who have received nirsevimab-alip (Beyfortus) in the same RSV season. The American Academy of Pediatrics stated that in July 2025 it no longer routinely recommends using Synagis.
Aetna · Identified Aug 13, 2026Medium impact
Clofarabine (CPB 0867, reviewed 2025-12-24)
Aetna considers clofarabine medically necessary for relapsed or refractory acute myeloid leukemia, for specified acute lymphoblastic leukemia indications including relapsed or refractory pediatric disease, for Langerhans cell histiocytosis in members 18 years of age or younger, and as conditioning for hematopoietic cell transplantation under the listed regimens. Continuation of clofarabine therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. All other indications, including B-cell lymphoma, breast cancer, Ewing sarcoma and myelodysplastic syndrome, are considered experimental, investigational, or unproven.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Genetic Testing for FLT3, NPM1, CEBPA, IDH1, and IDH2 Variants in Cytogenetically Normal Acute Myeloid Leukemia
Genetic testing for FLT3 internal tandem duplication (FLT3-ITD), NPM1, CEBPA, IDH1 and IDH2 variants may be considered medically necessary in cytogenetically normal acute myeloid leukemia (AML). Genetic testing for these variants is considered investigational in all other situations, and testing for FLT3 tyrosine kinase domain (FLT3-TKD) variants is considered investigational. Testing for FLT3, NPM1 and CEBPA variants to detect minimal residual disease is also considered investigational, and the testing is intended to guide management decisions in individuals who would receive treatment other than low-dose chemotherapy or best supportive care.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Hematopoietic Cell Transplantation for Acute Myeloid Leukemia
A 07/24/2026 review revised the policy statement on allogeneic HCT using a reduced-intensity conditioning regimen to remove the reference to Policy Guidelines, and the Code Reference section was updated to remove ICD-9 procedure and diagnosis codes. Allogeneic HCT with myeloablative conditioning may be considered medically necessary for poor- to intermediate-risk AML in first complete remission and for certain refractory or relapsed AML, while autologous HCT may be considered for AML in CR1 or beyond, or relapsed AML, in individuals who are not candidates for allogeneic HCT.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code C92.40?

There are 7 tracked policy changes affecting code C92.40, 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 C92.40?

Payers that have issued tracked updates for code C92.40 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code C92.40 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C92.40. 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 C92.40?

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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Avelumab (Bavencio) (CPB 0916, reviewed 2026-10-14)

Hematopoietic Cell Transplantation for Selected Leukemias (CPB 0640, reviewed 2026-09-11)

Gemtuzumab Ozogamicin (Mylotarg) (CPB 0922, reviewed 2026-05-28)

Palivizumab (Synagis) (CPB 0318, reviewed 2025-11-24)

Clofarabine (CPB 0867, reviewed 2025-12-24)

Genetic Testing for FLT3, NPM1, CEBPA, IDH1, and IDH2 Variants in Cytogenetically Normal Acute Myeloid Leukemia

Hematopoietic Cell Transplantation for Acute Myeloid Leukemia

What insurance policy changes affect code C92.40?

Which payers have updated policy for code C92.40?

How do I get notified when code C92.40 policy changes?

Why do payers change policies for code C92.40?