E85.81 Insurance Policy Changes

ICD-10 E85.81 is officially defined as "Light chain (AL) amyloidosis." code E85.81 is referenced in 9 tracked payer policy changes from Blue Cross Blue Shield of North Dakota, Independence Blue Cross, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code E85.81 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 · Effective Dec 10, 2026Medium impact
Pharmacy Policies Available Online
Blue Cross Blue Shield of North Dakota's pharmacy policy notice dated October 15, 2026 lists revisions to commercial prior authorization medical drug policies effective December 10, 2026, including Adzynma, Amtagvi, Benlysta IV, Berinert, Cinryze, Emrelis, Injectafer, Lutetium dotatate, Rituximab IV, Tecentriq IV, Tevimbra and Ziihera. Revisions to commercial post service claim edit medical drug policies, including Torisel and Xofigo, were effective November 1, 2026. Many of the entries update the contractor name to Wellpoint Federal and add the number of days allowed for authorization durations.
Independence Blue Cross · Effective Nov 2, 2026Medium impact
MA08.062l, Carfilzomib (Kyprolis®)
Independence Blue Cross updated the carfilzomib (Kyprolis) coverage policy effective 11/02/2026 to reflect current FDA labeling and NCCN guidelines. Medical necessity criteria for multiple myeloma were revised to add new combination regimens for transplant-deferred patients and relapsed/progressive disease, and coverage was expanded to include Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma with new ICD-10 diagnosis codes.
Independence Blue Cross · Effective Nov 2, 2026Medium impact
08.01.05n, Carfilzomib (Kyprolis®)
Independence Blue Cross updated its carfilzomib (Kyprolis) medical policy effective 11/02/2026 to align with FDA labeling and NCCN compendia. Medical necessity criteria for multiple myeloma were revised to add new combination regimens (including dexamethasone with belantamab mafodotin-blmf for relapsed/progressive disease), and new ICD-10 diagnosis codes were added for Waldenström Macroglobulinemia/Lymphoplasmacytic Lymphoma and related lymphomas to expand covered indications.
Harvard Pilgrim Health Care · Effective Nov 1, 2025Medium impact
Point32Health Medical Necessity Guideline updates
Point32Health is updating their Medical Necessity Guidelines effective November 1, 2025, making several services non-covered (autism interventions, Alzheimer's blood tests, ReActiv8 neurostimulation) while removing prior authorization requirements for tuberculosis testing, VEMP testing, and Cologuard Plus. Some codes will now require specific diagnosis codes for coverage.
Aetna · Identified Sep 29, 2026Medium impact
Bendamustine Products (CPB 0875, reviewed 2026-09-15)
Aetna's Clinical Policy Bulletin 0875 covers bendamustine products (Belrapzo, Bendeka, Treanda, Vivimusta and generic bendamustine) for commercial medical plans, and precertification is required for these products in applicable plan designs. Aetna considers bendamustine medically necessary for the listed indications when the stated criteria are met, including chronic lymphocytic leukemia/small lymphocytic leukemia, several B-cell and T-cell lymphomas, multiple myeloma, classic Hodgkin lymphoma, Waldenstrom macroglobulinemia, systemic light chain amyloidosis, autologous transplant conditioning and cold agglutinin disease. Aetna considers all other indications experimental, investigational, or unproven, including breast cancer, colorectal cancer, melanoma and non-small cell lung cancer.
Aetna · Identified Aug 13, 2026Medium impact
Plerixafor (CPB 0779, reviewed 2026-02-13)
Aetna's policy covers plerixafor (Mozobil or generic plerixafor) for hematopoietic stem cell mobilization when it is given after a granulocyte-colony stimulating factor such as filgrastim, after chemo-mobilization, or as part of a gene therapy protocol, and when it is not used beyond 4 consecutive days or after stem cell harvest or apheresis is complete. Continuation of therapy is considered medically necessary for members who meet the initial selection criteria. Aetna considers plerixafor experimental, investigational or unproven for all other indications, including the conditions listed in the policy such as acute leukemias, sickle cell disease, WHIM syndrome and neutropenia treatment.
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
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.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code E85.81?

There are 9 tracked policy changes affecting code E85.81, including updates from Blue Cross Blue Shield of North Dakota, Independence Blue Cross, Harvard Pilgrim Health Care. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for code E85.81?

Payers that have issued tracked updates for code E85.81 include: Blue Cross Blue Shield of North Dakota, Independence Blue Cross, Harvard Pilgrim Health Care, Aetna.

How do I get notified when code E85.81 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code E85.81. 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 E85.81?

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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Pharmacy Policies Available Online

MA08.062l, Carfilzomib (Kyprolis®)

08.01.05n, Carfilzomib (Kyprolis®)

Point32Health Medical Necessity Guideline updates

Bendamustine Products (CPB 0875, reviewed 2026-09-15)

Plerixafor (CPB 0779, reviewed 2026-02-13)

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

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

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

What insurance policy changes affect code E85.81?

Which payers have updated policy for code E85.81?

How do I get notified when code E85.81 policy changes?

Why do payers change policies for code E85.81?