What insurance policy changes affect code D03.9?

There are 5 tracked policy changes affecting code D03.9, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D03.9?

Payers that have issued tracked updates for code D03.9 include: Aetna.

How do I get notified when code D03.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D03.9. 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 D03.9?

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

D03.9 Insurance Policy Changes

ICD-10 D03.9 is officially defined as "Melanoma in situ, unspecified." code D03.9 is referenced in 5 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 D03.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 3, 2026Medium impact
Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-09-18)
Aetna considers percutaneous ethanol injection (PEI) medically necessary for hepatocellular carcinoma (HCC) without extra-hepatic spread and for neuroendocrine cancers involving the liver. Chemoembolization is medically necessary for neuroendocrine cancers involving the liver, unresectable primary HCC, liver-only metastasis from uveal melanoma, and pre-operative hepatic artery chemoembolization followed by orthotopic liver transplantation for HCC. Intra-hepatic microspheres (TheraSphere, SIR-Spheres, also known as trans-arterial radio-embolization) are medically necessary for neuroendocrine cancers involving the liver, unresectable primary HCC, unresectable liver tumors from primary colorectal cancer, unresectable and chemo-refractory intra-hepatic cholangiocarcinoma with liver metastases only, and pre-operative use as a bridge to orthotopic liver transplantation for HCC. Intra-hepatic chemotherapy is medically necessary for members with liver metastases from colorectal cancer. Many other uses are listed as experimental, investigational or unproven, including chemoembolization for palliative treatment of liver metastases from non-neuroendocrine primaries, PEI for liver neoplasms when the criteria above are not met, combined electrochemotherapy and immunotherapy for HCC, the TriNav Infusion System, the TheraBionic P1 System, and degradable starch microsphere chemoembolization for HCC.
Aetna · Identified Aug 17, 2026Medium impact
Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-04-16)
Aetna considers percutaneous ethanol injection, chemoembolization, intra-hepatic chemotherapy and intra-hepatic microspheres (also called TARE) medically necessary for listed liver indications. These include unresectable primary hepatocellular carcinoma (HCC), neuroendocrine tumors involving the liver, liver-only metastasis from uveal melanoma, unresectable liver tumors from colorectal cancer, and pre-operative use before liver transplantation for HCC. The policy considers many other uses experimental, investigational or unproven, including chemoembolization for liver metastases from non-neuroendocrine primaries, combined radiofrequency ablation and percutaneous ethanol injection for HCC, drug-eluting beads for liver metastases from colorectal cancer, the TriNav Infusion System and the TheraBionic P1 System.
Aetna · Identified Aug 15, 2026Medium impact
Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)
Aetna's Clinical Policy Bulletin 0815 covers ipilimumab (Yervoy) for commercial medical plans. It considers ipilimumab medically necessary for the cancer indications listed in the policy, many of them in combination with nivolumab, and considers continued treatment medically necessary for members requesting reauthorization when there is no evidence of unacceptable toxicity or disease progression. It considers ipilimumab experimental, investigational, or unproven for indications such as glioblastoma, pancreatic cancer, and prostate cancer, and for use with bevacizumab, vemurafenib, dabrafenib, or trametinib.
Aetna · Identified Aug 14, 2026Medium impact
Dendritic Cell Immunotherapy (CPB 0377, reviewed 2026-05-26)
Aetna considers dendritic cell immunotherapy experimental, investigational, or unproven because the peer-reviewed medical literature does not support its clinical use at this time, and there is no specific CPT or HCPCS code for it. ICD-10 codes for malignant neoplasms (leukemia, lymphoma, melanoma and solid tumors) and for melanoma in situ are listed as not covered for the indications in this bulletin. Current evidence is described as anecdotal, and randomized trials are needed to establish the appropriate antigen, adjuvant, dose, route and schedule.
Aetna · Identified Aug 13, 2026Medium impact
Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)
Aetna considers albumin-bound paclitaxel (Abraxane or generic albumin-bound paclitaxel) medically necessary for the cancers listed in its initial approval criteria, including Kaposi sarcoma, breast cancer, cutaneous melanoma, endometrial carcinoma, ovarian, fallopian tube and primary peritoneal cancer, biliary tract cancers, non-small cell lung cancer, pancreatic adenocarcinoma, small bowel adenocarcinoma, uveal melanoma, ampullary adenocarcinoma, cervical cancer, bladder cancer and vaginal cancer, when each cancer's stated criteria are met. All other indications are considered experimental, investigational, or unproven, including small cell lung cancer, prostate cancer, soft-tissue sarcoma and gastric cancer. Continuation of therapy is medically necessary for an approved indication when there is no evidence of unacceptable toxicity or disease progression on the current regimen.

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Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-09-18)

Liver and Other Neoplasms - Treatment Approaches (CPB 0268, reviewed 2026-04-16)

Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-07-16)

Dendritic Cell Immunotherapy (CPB 0377, reviewed 2026-05-26)

Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)

What insurance policy changes affect code D03.9?

Which payers have updated policy for code D03.9?

How do I get notified when code D03.9 policy changes?

Why do payers change policies for code D03.9?