What insurance policy changes affect code C94.20?

There are 2 tracked policy changes affecting code C94.20, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code C94.20?

Payers that have issued tracked updates for code C94.20 include: Aetna.

How do I get notified when code C94.20 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code C94.20. 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 C94.20?

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.

PAYER POLICY CHANGES

C94.20 Insurance Policy Changes

ICD-10 C94.20 is officially defined as "Acute megakaryoblastic leukemia not having achieved remission." code C94.20 is referenced in 2 tracked payer policy changes from Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code C94.20 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Only a small number of policies match this filter. Check back as coverage expands.

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 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.

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

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

What insurance policy changes affect code C94.20?

Which payers have updated policy for code C94.20?

How do I get notified when code C94.20 policy changes?

Why do payers change policies for code C94.20?