What insurance policy changes affect code D47.02?

There are 7 tracked policy changes affecting code D47.02, including updates from Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D47.02?

Payers that have issued tracked updates for code D47.02 include: Aetna.

How do I get notified when code D47.02 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D47.02. 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 D47.02?

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

D47.02 Insurance Policy Changes

ICD-10 D47.02 is officially defined as "Systemic mastocytosis." code D47.02 is referenced in 7 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 D47.02 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
Interferons (CPB 0404, reviewed 2026-09-10)
Aetna's interferon policy covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, mycosis fungoides/Sezary syndrome and severe malignant osteopetrosis, and considers all other indications experimental, investigational, or unproven. Pegasys (peginterferon alfa-2a) and Besremi (ropeginterferon alfa-2b-njft) each have their own list of covered indications, and several Besremi indications are covered only when Pegasys is unavailable. Aetna considers continuation of therapy medically necessary for members who are experiencing benefit, as evidenced by disease stability or disease improvement, and the Biojector 2000 needle-free injection system is considered a medically necessary alternative to needles for members with exacerbating-remitting MS who cannot safely self-inject due to tremors and decreased coordination.
Aetna · Identified Sep 30, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-08-21)
Aetna covers Prolia and its ten listed biosimilars, and Xgeva and its nine listed biosimilars, under commercial medical plans, and precertification is required for these denosumab products in applicable plan designs. Prolia is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis, based on criteria such as fragility fracture history, pre-treatment T-score, pre-treatment FRAX probability, and prior therapy response or intolerance. Xgeva is considered medically necessary for multiple myeloma, bone metastases from solid tumors, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis, and continuation of Xgeva requires disease stability or improvement.
Aetna · Identified Sep 29, 2026Medium impact
Omalizumab (CPB 0670, reviewed 2026-08-21)
Aetna Clinical Policy Bulletin 0670 sets the coverage criteria for omalizumab (Xolair) and its biosimilar omalizumab-igec (Omlyclo) under commercial medical plans. Covered indications are asthma, chronic rhinosinusitis with nasal polyps, chronic spontaneous urticaria, IgE-mediated food allergy, refractory immune checkpoint inhibitor-related pruritus, and systemic mastocytosis, each with listed criteria such as diagnosis, pre-treatment IgE level, prior therapy and continued positive clinical response. Precertification is required in applicable plan designs and the Site of Care Utilization Management Policy applies, and Aetna considers all other indications, including allergic rhinitis, atopic dermatitis and eosinophilic esophagitis, experimental, investigational or unproven.
Aetna · Identified Aug 19, 2026Medium impact
Zoledronic Acid (CPB 0524, reviewed 2026-02-12)
Aetna's clinical policy bulletin covers zoledronic acid for commercial medical plans. Zoledronic acid 5 mg (Reclast or generic) is considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, Paget's disease of bone, and treatment-related bone loss in men with prostate cancer receiving androgen deprivation therapy, when the listed criteria are met. Zoledronic acid 4 mg (formerly branded Zometa) is considered medically necessary for bone metastases from a solid tumor, certain breast cancer indications, hypercalcemia of malignancy, Langerhans cell histiocytosis with bone disease, multiple myeloma, and systemic mastocytosis with osteopenia or osteoporosis. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 16, 2026Medium impact
Interferons (CPB 0404, reviewed 2026-06-09)
Aetna covers Actimmune (interferon gamma-1b) for chronic granulomatous disease, severe malignant osteopetrosis, and mycosis fungoides/Sezary syndrome, and considers all other indications experimental, investigational, or unproven. Aetna covers peginterferon alfa-2a (Pegasys) for adult T-cell leukemia/lymphoma, chronic hepatitis B for up to a total of 48 weeks, chronic hepatitis C, chronic hepatitis E in liver transplant recipients who meet the ribavirin criteria, and several myeloproliferative, mastocytosis, and lymphoma indications. Ropeginterferon alfa-2b-njft (Besremi) is covered for polycythemia vera and for several other indications when peginterferon alfa-2a (Pegasys) is unavailable.
Aetna · Identified Aug 13, 2026Medium impact
Denosumab (CPB 0804, reviewed 2026-06-08)
Aetna's commercial medical policy sets coverage criteria for Prolia and its biosimilars and for Xgeva and its biosimilars, and precertification is required for these products in applicable plan designs. Prolia and its biosimilars are considered medically necessary for postmenopausal osteoporosis, osteoporosis in men, glucocorticoid-induced osteoporosis, bone loss in men receiving androgen deprivation therapy for prostate cancer, bone loss in women receiving adjuvant aromatase inhibitor therapy for breast cancer, and inhibiting progression of bone erosion in rheumatoid arthritis. Xgeva and its biosimilars are considered medically necessary for multiple myeloma, bone metastases from a solid tumor, giant cell tumor of bone, hypercalcemia of malignancy refractory to intravenous bisphosphonate therapy, and second-line therapy for osteopenia or osteoporosis in systemic mastocytosis. All other indications are considered experimental, investigational, or unproven, and combination therapy of denosumab with intravenous bisphosphonates is also considered experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Omalizumab (CPB 0670, reviewed 2026-06-05)
Aetna Clinical Policy Bulletin 0670 covers omalizumab (Xolair) and omalizumab-igec (Omlyclo) for commercial medical plans, and precertification is required for these products in applicable plan designs. Aetna considers omalizumab medically necessary for asthma, chronic rhinosinusitis with nasal polyps (CRSwNP), chronic spontaneous urticaria, IgE-mediated food allergy, immune checkpoint inhibitor-related toxicity and systemic mastocytosis when the listed criteria are met. Aetna considers all other indications experimental, investigational or unproven, and the Site of Care Utilization Management Policy applies to these products.

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Interferons (CPB 0404, reviewed 2026-09-10)

Denosumab (CPB 0804, reviewed 2026-08-21)

Omalizumab (CPB 0670, reviewed 2026-08-21)

Zoledronic Acid (CPB 0524, reviewed 2026-02-12)

Interferons (CPB 0404, reviewed 2026-06-09)

Denosumab (CPB 0804, reviewed 2026-06-08)

Omalizumab (CPB 0670, reviewed 2026-06-05)

What insurance policy changes affect code D47.02?

Which payers have updated policy for code D47.02?

How do I get notified when code D47.02 policy changes?

Why do payers change policies for code D47.02?