ICD-10 D72.119 is officially defined as "Hypereosinophilic syndrome [HES], unspecified." code D72.119 is referenced in 5 tracked payer policy changes from Blue Cross Blue Shield of North Dakota and Aetna. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code D72.119 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Blue Cross Blue Shield of North Dakota's August 2026 pharmacy update covers Medicaid Expansion medical drug prior authorization policies, with new policies and coding changes effective October 1, 2026. The most important billing change is the new HCPCS codes that replace older codes, such as Q5172 for Filkri and J9362 for Yondelis, plus added diagnosis codes for several drugs; the commercial pharmacy policies were reviewed with no changes listed.
Blue Cross Blue Shield of North Dakota updated its commercial pharmacy policies, and the revisions to the commercial prior authorization medical drug policies are effective September 9, 2026. Revisions to the commercial post service claim edit medical drug policies are effective August 1, 2026. Many of the prior authorization policies now state the number of days allowed for initial and renewal authorization durations, replace specific contraindications in the Universal Criteria with general language that the member does not have any FDA contraindications, and add covered ICD-10 diagnosis codes in Appendix 1.
Aetna's Clinical Policy Bulletin 0925 covers benralizumab (Fasenra) for commercial medical plans, and precertification is required for it in applicable plan designs. Aetna considers benralizumab medically necessary for severe asthma in members 6 years of age or older who meet the listed criteria, for eosinophilic granulomatosis with polyangiitis (EGPA) in members 18 years of age or older, and for hypereosinophilic syndrome (HES) in members 12 years of age or older. Aetna considers benralizumab experimental, investigational, or unproven for other conditions, including chronic obstructive pulmonary disease, acute bronchospasm, eosinophilic cystitis, eosinophilic pneumonia, eosinophilic annular erythema, laryngeal papillomatosis and status asthmaticus. Hypereosinophilic syndrome secondary to a non-hematologic cause and FIP1L1-PDGFRA kinase-positive HES are listed as exclusions.
Aetna considers mepolizumab (Nucala) medically necessary for commercial medical plans when the criteria for an indication are met. The covered indications are severe asthma, eosinophilic granulomatosis with polyangiitis (EGPA), hypereosinophilic syndrome (HES), chronic rhinosinusitis with nasal polyps (CRSwNP), and chronic obstructive pulmonary disease (COPD). Aetna considers all other indications experimental, investigational, or unproven, and the drug may not be used with another biologic or targeted synthetic drug for the same indication.
Aetna's clinical policy bulletin for benralizumab (Fasenra) applies to commercial medical plans. Precertification is required for all Aetna participating providers and members in applicable plan designs, and the Site of Care Utilization Management Policy applies to benralizumab for commercial plans. Benralizumab is medically necessary for severe asthma in members 6 years of age or older with an eosinophilic phenotype who meet the listed criteria, for EGPA in members 18 years of age or older, and for hypereosinophilic syndrome in members 12 years of age or older, and all other indications, including COPD, acute bronchospasm and eosinophilic pneumonia, are considered experimental, investigational, or unproven.
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