ICD-10 D46.A is officially defined as "Refractory cytopenia with multilineage dysplasia." code D46.A is referenced in 7 tracked payer policy changes from Independence Blue Cross, Excellus BlueCross BlueShield, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D46.A is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Independence Blue Cross updated MA08.011i to align with FDA labeling and NCCN guidelines for Erythropoiesis Stimulating Agents (ESAs). The policy revises medical necessity criteria for myelodysplastic syndrome, cancer-related anemia, HIV/AIDS, and pediatric chronic kidney disease, and adds 18 new ICD-10 diagnosis codes effective June 29, 2026.
Independence Blue Cross updated policy 08.00.75r on Erythropoiesis-Stimulating Agents (ESAs) effective June 15, 2026, revising coverage criteria for myelodysplastic syndrome, cancer-related anemia, HIV/AIDS, and pediatric chronic kidney disease based on updated FDA labeling and NCCN guidelines. Multiple ICD-10 diagnosis codes were added to the policy to align with current diagnostic classifications. Billing teams must update systems to recognize these new diagnosis codes when processing ESA claims.
Excellus medical policy 7.02.02 sets when allogeneic hematopoietic stem cell transplantation (allo-HSCT) is considered medically appropriate. It applies when the candidate meets the transplanting institution's selection criteria, the multidisciplinary team evaluates the individual and recommends treatment, and the individual is treated for one of the listed indications. The listed indications include acute and chronic leukemias, non-Hodgkin lymphoma, myelodysplastic diseases at intermediate or high risk, sickle cell anemia under stated criteria, transfusion-dependent thalassemia, bone marrow failure syndromes, severe combined immunodeficiency, hemophagocytic disorders, several storage and leukodystrophy disorders, and certain skeletal and metabolic bone disorders. Allo-HSCT is considered investigational for all other indications. The February 19, 2026 revision simplified the criteria to the indication level, removed the investigational indications list and added HCPCS code S2142.
Aetna Clinical Policy Bulletin 1032 addresses omidubicel-onlv (Omisirge) for commercial medical plans. Aetna considers it medically necessary for one dose total in members 12 years of age and older with a hematologic malignancy who will receive umbilical cord blood transplantation with myeloablative conditioning, and for one dose total in members 6 years of age and older with severe aplastic anemia (SAA) following reduced intensity conditioning. Aetna considers all other indications experimental, investigational, or unproven.
Aetna considers decitabine medically necessary for accelerated or blast phase myeloproliferative neoplasm, acute myeloid leukemia, blastic plasmacytoid dendritic cell neoplasm when used with venetoclax, classic Hodgkin lymphoma when used with pembrolizumab and refractory to at least three prior lines of therapy, myelodysplastic syndromes, and myelodysplastic syndrome/myeloproliferative neoplasm overlap neoplasms. Continuation of decitabine is considered medically necessary for those indications when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Aetna considers decitabine experimental, investigational, or unproven for all other indications, including colon, lung, melanoma, ovarian and other solid tumors, multiple myeloma, sickle cell disease, and use in combination with azacitidine.
Aetna's clinical policy bulletin for omidubicel-onlv (Omisirge) applies to commercial medical plans and states that precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers omidubicel-onlv medically necessary for one dose total in members 12 years of age and older with a hematologic malignancy who will receive umbilical cord blood transplantation, when the requested medication will be used to reduce the time to neutrophil recovery and incidence of infection and the member will receive myeloablative conditioning therapy. It is also considered medically necessary for one dose total in members 6 years of age and older with severe aplastic anemia (SAA) following reduced intensity conditioning therapy, and Aetna considers all other indications experimental, investigational, or unproven.
Epogen (epoetin alfa), Procrit (epoetin alfa), and Retacrit (epoetin alfa-epbx) are considered medically necessary for anemia related to zidovudine therapy in HIV-infected individuals, anemia in non-myeloid malignancies caused by concomitantly administered chemotherapy, anemia in individuals scheduled for elective, noncardiac, nonvascular surgery to reduce the need for allogeneic blood transfusions, and anemia associated with chronic kidney disease. Aranesp (darbepoetin alfa) is considered medically necessary for anemia associated with chronic kidney disease, including individuals on dialysis and not on dialysis, and for anemia in non-myeloid malignancies caused by concomitantly administered chemotherapy. The 09/09/2025 revision updated the indications descriptions and added that services related to delivery or administration of a medication determined to be not medically necessary are also considered not medically necessary.
Watch D46.A
Get one email when a payer policy names D46.A, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.
Get alerts for changes like this
Save a search and get email alerts when a new policy change matches your filters: daily or weekly, your choice, on every plan.