ICD-10 D15.0 is officially defined as "Benign neoplasm of thymus." code D15.0 is referenced in 6 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 D15.0 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.
Commercial prior authorization medical drug policies have revisions effective March 17, 2026, with many policies adding the Appendix A NQTL Factor Checklist, showing the number of days allowed for authorization durations, and replacing 'coverage' with 'prior authorization validity' in the initial and renewal criteria. Clinical updates include Eylea HD for macular edema following retinal vein occlusion, Breyanzi for relapsed or refractory marginal zone lymphoma, and new appendiceal neoplasm and cancer indications with ICD-10 codes D37.3 and Z85.038. Commercial post service claim edit policies for Trogarzo have revisions effective Feb. 1, 2026.
Aetna considers radiofrequency ablation (RFA) medically necessary for indications that include colorectal cancer liver metastases, colorectal cancer lung metastases of 5 cm or less where the primary colorectal tumor has been resected for cure (R0 resection), malignant lung masses in persons who are not candidates for surgical intervention, solitary hepatocellular carcinoma of 5 cm or less or multinodular early-stage HCC in members who are ineligible for or decline surgical resection or transplantation, renal cell carcinoma up to 4 cm in high-risk surgical candidates or in persons with renal insufficiency or a solitary kidney, and osteoid osteoma in individuals who remain symptomatic despite NSAIDs. Aetna considers RFA experimental, investigational, or unproven for combined RFA with transarterial chemoembolization for intermediate-stage hepatocellular carcinoma, combined endoluminal RFA and stenting for malignant biliary obstruction or stricture, combined RFA and vertebral cement augmentation for spinal metastases, endoscopic ultrasound-guided RFA for aldosterone-producing adenomas, and all other indications, including curative treatment of primary or metastatic malignant neoplasms in persons able to tolerate surgical resection, biliary obstructions or strictures, renal cysts, renal angiomyolipomas, Brunner's gland hyperplasia, and unresectable localized recurrent thyroid cancers without distant metastases.
Aetna covers durvalumab (Imfinzi) for commercial medical plans and considers it medically necessary for the listed cancer indications when that indication's criteria are met, including lung, small cell lung, biliary tract, cervical, colorectal, ampullary, pleural mesothelioma, hepatocellular, gastric, GEJ, esophageal, endometrial, bladder, and small bowel cancers. Members who have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy are not considered eligible, and Aetna considers all other indications experimental, investigational, or unproven. Continuation of therapy is covered under separate reauthorization criteria that require no evidence of unacceptable toxicity or disease progression, with stated limits such as up to 12 months for unresectable stage II or III NSCLC and up to 24 months total for limited stage SCLC.
Aetna considers cardiac MRI medically necessary for a defined list of cardiovascular indications, including thoracic aortic disease, pericardial disease, congenital heart disease, atrial fibrillation, coronary artery disease, cardiomyopathies, myocarditis and cardiac masses, and several of these require that an echocardiogram was inconclusive or expected to be non-diagnostic. Requests for indications not listed are subject to medical review, and when CT, radionuclide studies, ultrasound or other MRI are also performed, the physician must document the specific information the additional test is expected to provide. Aetna considers absolute quantification of myocardial blood flow, four-dimensional flow cardiac MRI, whole heart coronary MR angiography, ferumoxytol-enhanced cardiac MRI, and cardiac MRI used as a screening test to be experimental, investigational or unproven.
Aetna considers durvalumab (Imfinzi) medically necessary for commercial medical plans when the criteria for a listed indication are met, and considers all other indications experimental, investigational, or unproven. Precertification is required of all Aetna participating providers and members in applicable plan designs, and Aetna considers members not eligible for Imfinzi when they have experienced disease progression while on PD-1 or PD-L1 inhibitor therapy. Continuation of therapy is medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen, up to 12 months total for unresectable stage II or III NSCLC and up to 24 months total for limited stage SCLC.
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