D47.Z9 Insurance Policy Changes

ICD-10 D47.Z9 is officially defined as "Other specified neoplasms of uncertain behavior of lymphoid, hematopoietic and related tissue." code D47.Z9 is referenced in 21 tracked payer policy changes from Aetna, Excellus BlueCross BlueShield, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D47.Z9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Effective Jul 1, 2026High impact
Belantamab Mafodotin-blmf (Blenrep) (CPB 0981, reviewed 2026-02-06)
Precertification of belantamab mafodotin-blmf (Blenrep) is required of all Aetna participating providers and members in applicable plan designs, effective July 1, 2026. Aetna considers Blenrep medically necessary for relapsed or refractory multiple myeloma in combination with bortezomib and dexamethasone after at least two lines of prior therapy including a proteasome inhibitor and an immunomodulatory agent, as maintenance after 8 cycles of combination treatment with bortezomib and dexamethasone under that same prior-therapy condition, or as a single agent after at least three lines of prior therapy. Aetna also considers Blenrep medically necessary, alone or with bortezomib and dexamethasone, for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease, and plasma cell-related monoclonal gammopathy of renal significance, and considers all other indications experimental, investigational, or unproven.
Aetna · Effective Jul 1, 2026Medium impact
Belantamab Mafodotin-blmf (Blenrep) (CPB 0981, reviewed 2026-10-16)
Aetna requires precertification for belantamab mafodotin-blmf (Blenrep) for all Aetna participating providers and members in applicable plan designs, effective July 1, 2026. Aetna considers Blenrep medically necessary for relapsed or refractory multiple myeloma in combination with bortezomib and dexamethasone after at least two prior lines including a proteasome inhibitor and an immunomodulatory agent, as a single agent for maintenance after 8 cycles of bortezomib and dexamethasone with at least two prior lines including those agents, or as a single agent after at least three prior lines. Aetna also considers it medically necessary for POEMS syndrome, plasma cell-related MIDD and plasma cell-related MGRS, and considers all other indications experimental, investigational or unproven.
Excellus BlueCross BlueShield · Effective Feb 19, 2026Medium impact
Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02
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 · Effective Oct 17, 2025Medium impact
Linvoseltamab-gcpt (Lynozyfic) (CPB 1089, reviewed 2026-10-14)
Aetna's Clinical Policy Bulletin 1089 covers linvoseltamab-gcpt (Lynozyfic) for commercial medical plans, and precertification is required of all Aetna participating providers and members in applicable plan designs. Aetna considers Lynozyfic medically necessary for relapsed or refractory multiple myeloma after at least four prior therapies, including at least one proteasome inhibitor, one immunomodulatory agent, and one anti-CD38 monoclonal antibody. It is also considered medically necessary as a single agent for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease, or plasma cell-related monoclonal gammopathy of renal significance, and Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Effective Oct 17, 2025Medium impact
Linvoseltamab-gcpt (Lynozyfic) (CPB 1089, reviewed 2026-07-17)
Aetna Clinical Policy Bulletin 1089 covers linvoseltamab-gcpt (Lynozyfic) for commercial medical plans, and Medicare criteria are in a separate document. Aetna considers it medically necessary for relapsed or refractory multiple myeloma after at least four prior therapies, including at least one drug from each of three classes: a proteasome inhibitor, an immunomodulatory agent, and an anti-CD38 monoclonal antibody. It is also considered medically necessary as a single agent for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease (MIDD), or plasma cell-related monoclonal gammopathy of renal significance (MGRS). Continuation is considered medically necessary for an indication listed in the initial criteria when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Nov 3, 2026Medium impact
Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2026-11-02)
Aetna's Clinical Policy Bulletin 0992 (reviewed 2026-11-02) establishes coverage criteria for idecabtagene vicleucel (Abecma), a CAR-T cell therapy for relapsed or refractory multiple myeloma and three rare plasma cell disorders (POEMS, MIDD, MGRS). The policy requires precertification for all covered indications and specifies detailed clinical eligibility criteria, including prior treatment requirements, performance status, organ function, and exclusions for CNS involvement and active infections. All other indications are considered experimental and not covered.
Aetna · Identified Oct 12, 2026Medium impact
Talquetamab-tgvs (Talvey) (CPB 1042, reviewed 2026-10-09)
Aetna's Clinical Policy Bulletin 1042 covers talquetamab-tgvs (Talvey) for commercial medical plans, and precertification of Talvey is required of all Aetna participating providers and members in applicable plan designs. Aetna considers Talvey medically necessary for relapsed or refractory multiple myeloma as a bridge to BCMA CAR T-cell therapy after at least three prior lines of therapy that include an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 monoclonal antibody, as a single agent after at least four prior therapies including one drug from each of those categories, or in combination with teclistamab-cqyv after at least three prior therapies. Aetna also considers Talvey medically necessary for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease and plasma cell-related monoclonal gammopathy of renal significance, alone or with teclistamab-cqyv, and considers all other indications 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 17, 2026Medium impact
Hematopoietic Cell Transplantation for Multiple Myeloma (CPB 0497, reviewed 2026-08-05)
Aetna considers autologous hematopoietic cell transplantation medically necessary for multiple myeloma or POEMS syndrome when the transplanting institution's written eligibility criteria are met. Without such criteria, it is considered medically necessary when the member has no significant co-morbid medical conditions and adequate major organ function based on the transplant institution's evaluation, and indolent myeloma, smoldering myeloma and MGUS are excluded. Allogeneic transplant is considered medically necessary for multiple myeloma or POEMS syndrome when the member meets the transplanting institution's protocol criteria, or without a protocol when the member has adequate major organ function and early relapse (less than 24 months) after primary therapy that included an autologous transplant (multiple myeloma only). Tandem transplants require protocol criteria or, without a protocol, active myeloma with the first and second transplants planned within a 6-month period, and exclusions include inadequate cardiac, pulmonary or hepatic function, another life-limiting cancer, and psychiatric disease that would interfere with the regimen. The use of natural killer cells in autologous stem cell transplantation for multiple myeloma is considered experimental, investigational or unproven.
Aetna · Identified Aug 17, 2026Medium impact
Teclistamab-cqyv (Tecvayli) (CPB 1018, reviewed 2026-06-08)
Aetna's Clinical Policy Bulletin 1018 covers teclistamab-cqyv (Tecvayli) for commercial medical plans and requires precertification from Aetna for participating providers and members in applicable plan designs. Aetna considers it medically necessary for relapsed or refractory multiple myeloma when specific criteria are met: use with daratumumab (Darzalex) or daratumumab and hyaluronidase-fihj (Darzalex Faspro) in a member who is bortezomib-refractory or lenalidomide-refractory; use as a single agent after at least 4 prior therapies that include a proteasome inhibitor, an immunomodulatory agent and an anti-CD38 monoclonal antibody; or use with talquetamab-tgvs (Talvey) after at least 3 prior therapies. It also covers POEMS syndrome, monoclonal immunoglobulin deposition disease (MIDD) and plasma cell-related monoclonal gammopathy of renal significance (MGRS) under the stated criteria. Aetna considers all other indications experimental, investigational or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression.
Aetna · Identified Aug 17, 2026Medium impact
Talquetamab-tgvs (Talvey) (CPB 1042, reviewed 2026-05-19)
Aetna considers talquetamab-tgvs (Talvey) medically necessary for relapsed or refractory multiple myeloma when one of the listed criteria is met: use as a bridge to BCMA CAR T-cell therapy after at least three lines of therapy including an immunomodulatory agent, a proteasome inhibitor and an anti-CD38 monoclonal antibody; single-agent use after at least four prior therapies including one drug from each of those categories; or use in combination with teclistamab-cqyv (Tecvayli) after at least three prior therapies. Aetna also considers it medically necessary for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease (MIDD) and plasma cell-related monoclonal gammopathy of renal significance (MGRS), as a single agent or in combination with teclistamab-cqyv, and considers all other indications experimental, investigational, or unproven. Precertification is required of all Aetna participating providers and members in applicable plan designs.
Aetna · Identified Aug 15, 2026Medium impact
Isatuximab-irfc (Sarclisa) (CPB 0969, reviewed 2026-03-02)
Aetna covers Sarclisa (isatuximab-irfc) for commercial members with multiple myeloma when one of its listed criteria is met, including use with pomalidomide and dexamethasone after at least two prior therapies that include lenalidomide and a proteasome inhibitor, and use as primary therapy with bortezomib, lenalidomide and dexamethasone or with carfilzomib, lenalidomide and dexamethasone. The policy also covers POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease and plasma cell-related monoclonal gammopathy of renal significance, and continued use is covered when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Isatuximab used with atezolizumab or cemiplimab for solid tumors or lymphoma, and isatuximab for acute lymphoblastic leukemia, Duchenne muscular dystrophy, light chain amyloidosis or soft tissue plasmacytoma, are considered experimental, investigational or unproven.
Aetna · Identified Aug 15, 2026Medium impact
Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2025-12-19)
Aetna considers idecabtagene vicleucel (Abecma) medically necessary for relapsed or refractory multiple myeloma in members 18 years of age and older when all listed criteria are met, and for POEMS syndrome, plasma cell-related MIDD, and plasma cell-related MGRS when the criteria for those conditions are met. For multiple myeloma, the member must have received at least two lines of therapy including an immunomodulatory agent, a proteasome inhibitor, and an anti-CD38 monoclonal antibody, must not have received a previous treatment course of Abecma or another CAR T-cell therapy directed at any target, and must have an ECOG performance status of 0 to 2. Aetna considers all other indications experimental, investigational, or unproven, and considers idecabtagene vicleucel experimental, investigational, or unproven for solid tumors.
Aetna · Identified Aug 15, 2026Medium impact
Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)
Quantitative sensory testing (QST), current perception threshold (CPT) testing, voltage-actuated sensory nerve conduction threshold (VsNCT) testing, and quantitative thermal testing for early diagnosis of leprosy are considered experimental, investigational, or unproven for the uses listed in this policy, because their effectiveness or clinical value has not been established. Listed uses include evaluating fibromyalgia pain, chronic itch, chronic pelvic pain, and shoulder pain, and diagnosing restless legs syndrome and small fiber neuropathy in postural orthostatic tachycardia syndrome. CPT codes 0106T through 0110T and HCPCS code G0255 are not covered for the listed indications.
Aetna · Identified Aug 13, 2026Medium impact
Elotuzumab (Empliciti) (CPB 0899, reviewed 2026-03-02)
Aetna Clinical Policy Bulletin 0899 covers elotuzumab (Empliciti) for commercial medical plans and requires precertification for all Aetna participating providers and members in applicable plan designs. Aetna considers elotuzumab medically necessary for previously treated multiple myeloma when it is used with lenalidomide and dexamethasone, with bortezomib and dexamethasone, or with pomalidomide and dexamethasone in members who have received at least two prior therapies, including an immunomodulatory agent and a proteasome inhibitor. The same combinations are considered medically necessary for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease, and plasma cell-related monoclonal gammopathy of renal significance, and all other indications, including newly diagnosed multiple myeloma and smoldering multiple myeloma, are considered experimental, investigational, or unproven.
Aetna · Identified Aug 13, 2026Medium impact
Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro) (CPB 0904, reviewed 2026-06-08)
Aetna considers daratumumab (Darzalex) and daratumumab and hyaluronidase-fihj (Darzalex Faspro) medically necessary for the listed indications, including multiple myeloma regimens, systemic light chain amyloidosis, HIV-related plasmablastic lymphoma used with dose-adjusted EPOCH, relapsed or refractory T-cell acute lymphoblastic leukemia, POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease, and plasma cell-related monoclonal gammopathy of renal significance, when each listed criteria set is met. Continuation of therapy is considered medically necessary on reauthorization when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Aetna considers all other indications experimental, investigational, or unproven.
Aetna · Identified Aug 12, 2026Medium impact
Carfilzomib (Kyprolis) (CPB 0845, reviewed 2026-03-02)
Aetna's Clinical Policy Bulletin 0845 sets the commercial coverage criteria for carfilzomib (Kyprolis). Aetna considers carfilzomib medically necessary for multiple myeloma when the member meets the criteria for one of the listed combinations and lines of therapy, and also for POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease and monoclonal gammopathy of renal significance, systemic light chain amyloidosis, and Waldenstrom macroglobulinemia or lymphoplasmacytic lymphoma when used with rituximab and dexamethasone. Aetna considers all other indications experimental, investigational, or unproven, including the cancers, osteoporosis and systemic lupus erythematosus listed in the policy.
Aetna · Identified Aug 12, 2026Medium impact
Ciltacabtagene Autoleucel (Carvykti) (CPB 1007, reviewed 2026-03-13)
Aetna's commercial medical policy CPB 1007 covers ciltacabtagene autoleucel (Carvykti) as a single dose for relapsed or refractory multiple myeloma in members 18 years of age and older who meet the listed criteria. The policy also covers POEMS syndrome, plasma cell-related monoclonal immunoglobulin deposition disease and plasma cell-related monoclonal gammopathy of renal significance under separate criteria. Precertification is required. Aetna considers the drug experimental, investigational or unproven for solid tumors.
Aetna · Identified Aug 12, 2026Medium impact
Bortezomib Products (CPB 0675, reviewed 2026-02-17)
Aetna Clinical Policy Bulletin 0675, last reviewed 02/17/2026, sets commercial medical coverage criteria for bortezomib (Velcade, Boruzu, or generic bortezomib). Aetna considers bortezomib medically necessary for acute lymphoblastic leukemia, adult T-cell leukemia/lymphoma as a single agent for subsequent therapy, Kaposi sarcoma as subsequent therapy, antibody mediated rejection of solid organ, relapsed or refractory follicular lymphoma, relapsed or refractory pediatric classic Hodgkin lymphoma, mantle cell lymphoma, multicentric Castleman disease as subsequent therapy, multiple myeloma, POEMS syndrome, plasma cell-related MIDD and MGRS, systemic light chain amyloidosis, and Waldenström macroglobulinemia/lymphoplasmacytic lymphoma, and considers all other indications experimental, investigational, or unproven, including acute myeloid leukemia, glioblastoma multiforme, and smoldering (asymptomatic) myeloma. Approvals may be subject to dosing limits, and for all indications dosing does not exceed 1.6 mg/m2 per dose or require more than 7 doses per 30-day period.
Aetna · Identified Aug 12, 2026Medium impact
Bendamustine Products (CPB 0875, reviewed 2026-02-24)
Precertification of bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta, and generic bendamustine) is required of all Aetna participating providers and members in applicable commercial plan designs. Aetna considers bendamustine medically necessary for CLL or SLL without chromosome 17p deletion or TP53 mutation, and for listed B-cell lymphomas, T-cell lymphomas, multiple myeloma, POEMS syndrome, plasma cell-related MIDD and MGRS, classic Hodgkin lymphoma, nodular lymphocyte predominant Hodgkin lymphoma, Waldenstrom macroglobulinemia, systemic light chain amyloidosis, autologous transplant conditioning, and cold agglutinin disease when the listed criteria are met. Aetna considers all other indications experimental, investigational, or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms
8.01.21 on allogeneic hematopoietic cell transplantation for myelodysplastic syndromes and myeloproliferative neoplasms. Myeloablative allogeneic transplant may be considered medically necessary as a treatment for these disorders, and reduced-intensity conditioning allogeneic transplant may be considered medically necessary as a risk-adapted treatment for individuals at high risk of intolerance of a myeloablative regimen. Myeloablative or reduced-intensity allogeneic transplant for cases that do not meet the policy guidelines criteria is investigational. A 07/23/2026 policy review updated the description with minor changes, left the policy statements unchanged and removed ICD-9 procedure and diagnosis codes from the code reference.

Watch D47.Z9

Get one email when a payer policy names D47.Z9, a payer adds or drops it from a prior auth list, or Medicare changes its NCCI pairs, unit limit, payment or coverage articles.

No account needed. We send a confirmation link first, and every email has a one-click stop link.

FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D47.Z9?

There are 21 tracked policy changes affecting code D47.Z9, including updates from Aetna, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D47.Z9?

Payers that have issued tracked updates for code D47.Z9 include: Aetna, Excellus BlueCross BlueShield, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code D47.Z9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D47.Z9. 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.Z9?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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.

Create a free alert How Policy Monitoring works

Belantamab Mafodotin-blmf (Blenrep) (CPB 0981, reviewed 2026-02-06)

Belantamab Mafodotin-blmf (Blenrep) (CPB 0981, reviewed 2026-10-16)

Allogeneic Hematopoietic Stem Cell Transplantation (Allo-HSCT) 7.02.02

Linvoseltamab-gcpt (Lynozyfic) (CPB 1089, reviewed 2026-10-14)

Linvoseltamab-gcpt (Lynozyfic) (CPB 1089, reviewed 2026-07-17)

Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2026-11-02)

Talquetamab-tgvs (Talvey) (CPB 1042, reviewed 2026-10-09)

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

Hematopoietic Cell Transplantation for Multiple Myeloma (CPB 0497, reviewed 2026-08-05)

Teclistamab-cqyv (Tecvayli) (CPB 1018, reviewed 2026-06-08)

Talquetamab-tgvs (Talvey) (CPB 1042, reviewed 2026-05-19)

Isatuximab-irfc (Sarclisa) (CPB 0969, reviewed 2026-03-02)

Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2025-12-19)

Quantitative Sensory Testing Methods (CPB 0357, reviewed 2026-05-22)

Elotuzumab (Empliciti) (CPB 0899, reviewed 2026-03-02)

Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro) (CPB 0904, reviewed 2026-06-08)

Carfilzomib (Kyprolis) (CPB 0845, reviewed 2026-03-02)

Ciltacabtagene Autoleucel (Carvykti) (CPB 1007, reviewed 2026-03-13)

Bortezomib Products (CPB 0675, reviewed 2026-02-17)

Bendamustine Products (CPB 0875, reviewed 2026-02-24)

Allogeneic Hematopoietic Cell Transplantation for Myelodysplastic Syndromes and Myeloproliferative Neoplasms

What insurance policy changes affect code D47.Z9?

Which payers have updated policy for code D47.Z9?

How do I get notified when code D47.Z9 policy changes?

Why do payers change policies for code D47.Z9?