D49.9 Insurance Policy Changes

ICD-10 D49.9 is officially defined as "Neoplasm of unspecified behavior of unspecified site." code D49.9 is referenced in 9 tracked payer policy changes from Presbyterian Health Plan and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D49.9 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Presbyterian Health Plan · Effective Mar 3, 2026High impact
2026 March Network Connection
Effective March 3, 2026, prior authorization from Evolent is required before oncology chemotherapeutic drugs, supportive agents, symptom management medications and radiation oncology services are administered, for Presbyterian members of all ages with primary diagnoses in the range C00 to D49.9 or E34.0, E34.01 and E34.09. Presbyterian will stop creating secondary claims for dual coverage members on March 13, 2026, so providers will need to submit both primary and secondary claims. HCA is scheduled to go live with Turquoise Claims on March 23, 2026, and telehealth originating site fee Q3014 may only be billed by the eligible facility where the member is physically located.
Aetna · Identified Oct 23, 2026Medium impact
Tumor Chemoresistance Assays (CPB 0758, reviewed 2026-10-21)
Aetna considers tumor chemoresistance assays experimental, investigational, or unproven because there is insufficient evidence that these assays influence management decisions such that clinical outcomes are improved. Aetna considers the Onco4D biodynamic chemotherapy selection assay experimental, investigational, or unproven for the same reason. The policy lists CPT 0083U, which covers the Onco4D assay, among CPT codes not covered for the indications listed in the policy.
Aetna · Identified Oct 7, 2026Medium impact
Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)
Aetna considers measurement of plasma brain natriuretic peptide (BNP) medically necessary to differentiate dyspnea due to heart failure from pulmonary disease, to determine prognosis or severity in chronic heart failure, to screen for heart failure annually in adults with diabetes mellitus, to measure upon hospital admission and before discharge in acutely decompensated heart failure, for preoperative cardiac risk assessment before elevated-risk noncardiac surgery in members with known cardiovascular disease, age 65 or older, or age 45 or older with cardiovascular symptoms, and as an adjunct test for risk stratification of Stage C aortic stenosis. Serial BNP and NT-proBNP measurements and the other uses listed in the policy, such as diagnosing Kawasaki disease, are considered experimental, investigational, or unproven. CPT 83880 is covered when the selection criteria are met, except as a cardiovascular biomarker in healthy normal subjects and for identifying stress-induced myocardial ischemia.
Aetna · Identified Aug 19, 2026Medium impact
Intensity Modulated Radiation Therapy (CPB 0590, reviewed 2025-12-02)
Aetna considers intensity modulated radiation therapy (IMRT) medically necessary for certain indications where critical structures cannot be adequately protected with standard 3D conformal radiotherapy, and points to the eviCore Healthcare Radiation Therapy Clinical Guidelines for the medical necessity criteria. Placement of fiducial markers is medically necessary if the criteria are met, the radiation target is not clearly visible, and bony anatomy is not sufficient for adequate target alignment. Inter-fraction or intra-fraction image guidance for delivering IMRT and other conformal radiotherapy is also listed as medically necessary, and IMRT is considered experimental, investigational, or unproven and not medically necessary for right breast cancer and for all other indications not in the appendix list.
Aetna · Identified Aug 16, 2026Medium impact
Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2025-11-26)
Aetna considers intermittent intravenous insulin therapy experimental, investigational, or unproven for diabetes mellitus and all other indications. This covers the therapy under its other names, including hepatic activation therapy, metabolic activation therapy, physiologic insulin re-sensitization (PIR) infusions, pulse insulin therapy, and the Trina Health artificial pancreas treatment. Aetna also considers insulin potentiation therapy experimental for arthritis, cancer, infectious diseases, and other conditions, and considers blood glucose, potassium, respiratory quotient, and urine urea nitrogen tests experimental when performed in the context of intermittent intravenous insulin therapy. The policy does not apply to insulin infusions for diabetic ketoacidosis or hyperosmolar coma.
Aetna · Identified Aug 14, 2026Medium impact
Near-Infrared Vascular Imaging and Near-Infrared Fluorescence Imaging (CPB 0846, reviewed 2025-12-04)
Aetna considers near-infrared vascular imaging and near-infrared fluorescence imaging experimental, investigational, or unproven for the indications listed in the policy. These include intra-operative fluorescence imaging of extra-hepatic bile ducts with indocyanine green for assessment of liver function, intra-parenchymal near-infrared spectroscopy for detection of delayed cerebral ischemia in aneurysmal subarachnoid hemorrhage, sentinel lymph node detection with indocyanine green in cutaneous melanoma and oral squamous cell carcinoma, and Cision InVision short-wave infrared imaging for pathological imaging. Other listed indications include diagnosis of peripheral artery disease, diagnosis of rheumatoid arthritis, sentinel lymph node mapping in endometrial cancer, transcutaneous NIR spectroscopy for monitoring kidney and liver allograft perfusion, and near-infrared vascular imaging systems for assessment of cutaneous wound and guiding vascular access.
Aetna · Identified Aug 12, 2026Medium impact
Antineoplaston Therapy (CPB 0240, reviewed 2026-04-13)
Aetna considers antineoplaston therapy (auto-urine therapy) experimental, investigational, or unproven because the effectiveness of these approaches has not been established. The following services associated with antineoplaston therapy are also listed as experimental, investigational, or unproven: ancillary diagnostic laboratory, x-rays, MRI or CT scans done to monitor the therapy; infusion pump and intravenous supplies for use with the infusion pump; placement of Hickman catheter; and oral antineoplaston therapy or associated physician services for administering and monitoring oral antineoplaston treatment. Antineoplaston therapy is not approved by the Food and Drug Administration (FDA) for any indication.
Aetna · Identified Aug 12, 2026Medium impact
Tumor Chemoresistance Assays (CPB 0758, reviewed 2025-12-02)
Aetna considers tumor chemoresistance assays experimental, investigational, or unproven because there is insufficient evidence that these assays influence management decisions such that clinical outcomes are improved. Aetna also considers the Onco4D biodynamic chemotherapy selection assay experimental, investigational, or unproven for the same reason. The listed CPT codes are not covered for the indications listed in the policy.
Aetna · Identified Aug 12, 2026Medium impact
Tumor Chemosensitivity Assays (CPB 0245, reviewed 2026-04-13)
Aetna considers the tumor chemosensitivity assays named in this policy experimental, investigational, or unproven, because there is insufficient evidence that they influence management decisions such that clinical outcomes are improved. The named assays include 3D Predict Glioma, 3D Predict Ovarian, ChemoFx, differential staining cytotoxicity (DiSC), Cytoprint, the human tumor cloning assay, the human tumor stem cell assay, MTT, the MiCK apoptosis assay (CorrectChemo), NexGen, PARIS Test, PredicineATLAS, and Reverse Phase Protein Array (Theralink), along with cancer stem cell chemotherapeutic drug cytotoxicity assays such as ChemoID, ChemoID Lab and Cordgenics. Aetna also considers circulating tumor DNA use for surveillance of adjuvant chemosensitivity and regimen adjustment in colon cancer experimental, investigational, or unproven. The policy was last reviewed 04/13/2026 with the next review set for 03/11/2027.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D49.9?

There are 9 tracked policy changes affecting code D49.9, including updates from Presbyterian Health Plan, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code D49.9?

Payers that have issued tracked updates for code D49.9 include: Presbyterian Health Plan, Aetna.

How do I get notified when code D49.9 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D49.9. 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 D49.9?

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.

All billing codes J3590 C9399 J3490 99215 99213 99202

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2026 March Network Connection

Tumor Chemoresistance Assays (CPB 0758, reviewed 2026-10-21)

Brain Natriuretic Peptide Testing (CPB 0618, reviewed 2026-09-29)

Intensity Modulated Radiation Therapy (CPB 0590, reviewed 2025-12-02)

Intermittent Intravenous Insulin Therapy (CPB 0742, reviewed 2025-11-26)

Near-Infrared Vascular Imaging and Near-Infrared Fluorescence Imaging (CPB 0846, reviewed 2025-12-04)

Antineoplaston Therapy (CPB 0240, reviewed 2026-04-13)

Tumor Chemoresistance Assays (CPB 0758, reviewed 2025-12-02)

Tumor Chemosensitivity Assays (CPB 0245, reviewed 2026-04-13)

What insurance policy changes affect code D49.9?

Which payers have updated policy for code D49.9?

How do I get notified when code D49.9 policy changes?

Why do payers change policies for code D49.9?