D64.81 Insurance Policy Changes

ICD-10 D64.81 is officially defined as "Anemia due to antineoplastic chemotherapy." code D64.81 is referenced in 6 tracked payer policy changes from Independence Blue Cross, Aetna, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D64.81 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Independence Blue Cross · Effective Mar 23, 2026Medium impact
MA08.150a, Intravenous (IV) Iron Preparations
Independence Blue Cross Medicare Advantage policy MA08.150b (effective 03/23/2026) supersedes MA08.150a with new coverage criteria for IV iron in pediatric patients and expanded ICD-10 diagnosis codes including pregnancy-related anemia (O99.011-O99.013, O99.019, O99.02, O99.03) and chemotherapy-induced anemia (D64.81). The policy maintains preferred vs. nonpreferred product tiering for adults 18+ and excludes preferred product requirements for patients under 18 and pregnant individuals.
Independence Blue Cross · Effective Mar 23, 2026Medium impact
MA08.150a, Intravenous (IV) Iron Preparations
Independence Blue Cross updated MA08.150a to MA08.150b, adding new coverage criteria for pediatric IV iron use and expanding ICD-10 diagnosis codes to include pregnancy-related anemias (O99.011-O99.019, O99.02, O99.03) and chemotherapy-induced anemia (D64.81). The policy maintains preferred vs. nonpreferred product designations with specific coverage rules based on prior treatment history and contraindication documentation.
Independence Blue Cross · Effective Mar 23, 2026Medium impact
08.02.29a, Intravenous (IV) Iron Preparations
Independence Blue Cross updated policy 08.02.29a to 08.02.29b, adding new coverage criteria for pediatric IV iron preparations, expanding ICD-10 diagnosis codes to include pregnancy-related anemia and heart failure conditions, and clarifying preferred vs. nonpreferred product designations. Billing teams must implement these expanded diagnosis codes and ensure claims reflect the new clinical criteria effective March 23, 2026.
Independence Blue Cross · Effective Mar 23, 2026Medium impact
08.02.29a, Intravenous (IV) Iron Preparations
Independence Blue Cross updated IV Iron Preparations policy (08.02.29b, effective 03/23/2026) to add new coverage criteria for pediatric patients and expand ICD-10 diagnosis codes to include pregnancy-related anemias, anemia in neoplastic disease, chemotherapy-induced anemia, and heart failure. The preferred product hierarchy remains unchanged for adults, but new clinical scenarios now have defined coverage pathways.
Aetna · Identified Aug 16, 2026Medium impact
Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)
Feraheme, Ferrlecit, Injectafer, Monoferric and Venofer are medically necessary only for commercial members who have a contraindication, intolerance or ineffective response to the lower cost alternatives generic ferumoxytol, generic iron sucrose, generic sodium ferric gluconate and INFeD (iron dextran) for the labeled indication. Precertification is required for Feraheme, Ferrlecit, generic sodium ferric gluconate, Injectafer, Monoferric, Venofer and generic iron sucrose in applicable plan designs. Intravenous iron is considered experimental, investigational or unproven for other indications, including acute mountain sickness and anemia of inflammation, and it is contraindicated for genetic hemochromatosis or hemochromatosis secondary to iron overload.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Erythropoiesis-Stimulating Agents
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code D64.81?

There are 6 tracked policy changes affecting code D64.81, including updates from Independence Blue Cross, Aetna, 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 D64.81?

Payers that have issued tracked updates for code D64.81 include: Independence Blue Cross, Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code D64.81 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code D64.81. 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 D64.81?

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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MA08.150a, Intravenous (IV) Iron Preparations

MA08.150a, Intravenous (IV) Iron Preparations

08.02.29a, Intravenous (IV) Iron Preparations

08.02.29a, Intravenous (IV) Iron Preparations

Intravenous Iron Therapy (CPB 0575, reviewed 2026-07-01)

Erythropoiesis-Stimulating Agents

What insurance policy changes affect code D64.81?

Which payers have updated policy for code D64.81?

How do I get notified when code D64.81 policy changes?

Why do payers change policies for code D64.81?