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Q2055

PAYER POLICY CHANGES

Q2055 Insurance Policy Changes

HCPCS Q2055 is officially defined as "Idecabtagene vicleucel, up to 510 million autologous b-cell maturation antigen (bcma) directed car-positive t cells, including leukapheresis and dose preparation procedures, per therapeutic dose." HCPCS Q2055 is referenced in 9 tracked payer policy changes from Independence Blue Cross, Humana, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS Q2055 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 Feb 9, 2026High impact
MA08.190, Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma®
Independence Blue Cross Medicare Advantage has published a new policy (MA08.190) effective 02/09/2026 that consolidates CAR-T therapy coverage for two drugs: Carvykti® (ciltacabtagene autoleucel) and Abecma® (idecabtagene vicleucel). This policy supersedes the previous policy 08.01.43q and now includes expanded indications for POEMS, MIDD, and MGRS in addition to relapsed/refractory multiple myeloma. Billing teams must update systems to recognize the new policy number and ensure claims comply with the updated medical necessity criteria, including prior treatment requirements and organ function assessments.
Humana · Effective Aug 3, 2026Medium impact
Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage (Revised)
Humana Medicare Advantage has updated its CAR T-cell Therapy medical coverage policy (effective 08/03/2026), providing standardized coverage determination criteria across all approved CAR-T therapies. The policy establishes specific billing codes (CPT 38225-38228, HCPCS Q2041-Q2058, ICD-10-PCS XW033/XW043 codes) and references individual pharmacy policies for each CAR-T product. Billing teams must ensure claims align with the referenced drug-specific pharmacy policies to avoid denials.
Independence Blue Cross · Effective Feb 9, 2026Medium impact
08.02.50, Chimeric Antigen Receptor Therapy (CART): Carvykti® & Abecma®
Independence Blue Cross has published a new CAR-T therapy policy (08.02.50) effective 02/09/2026 that consolidates coverage for Carvykti and Abecma, replacing the previous policy 08.01.43q. The policy expands approved indications to include POEMS, MIDD, and plasma cell–related MGRS in addition to relapsed/refractory multiple myeloma, with specific medical necessity criteria and organ function requirements for both drugs.
CareSource · Effective Nov 1, 2025Medium impact
[Ohio] Audaire Health Provider Portal
Effective November 1, 2025, CareSource Ohio requires providers administering CAR-T cell therapies to attest that they will submit clinical outcomes data to the Audaire Health provider portal. Prior authorization approvals for any of seven currently available CAR-T therapies will require this attestation. Providers must track and report outcomes at 3, 6, 12, and 24 months post-authorization through the Audaire portal or by phone/fax.
Humana · Effective Sep 2, 2025Medium impact
Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage (Revised)
Humana Medicare Advantage has updated their CAR T-cell therapy policy with new CPT codes effective January 1, 2025, transitioning from temporary Category III codes to permanent CPT codes. The policy also adds a new HCPCS code for obecabtagene autoleucel effective April 1, 2025.
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 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
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.

Watch Q2055

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REFERENCE DATA

Payers with rules20

Payers requiring prior auth20

Aetna · Effective November 1, 2026
Prior authorization required
Participating provider precertification list for Aetna
Anthem BCBS · Effective November 1, 2026
Prior authorization required
Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)
Fidelis Care · Effective November 1, 2026
Prior authorization required
Fidelis Care Metal-Level Products authorization grid

FREQUENTLY ASKED QUESTIONS

Does Aetna require prior authorization for Q2055?

Aetna lists Q2055 on Participating provider precertification list for Aetna for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Ambetter require prior authorization for Q2055?

Ambetter lists Q2055 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for Q2055?

AmeriHealth Caritas lists Q2055 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for Q2055?

Anthem BCBS lists Q2055 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for Q2055?

Arizona Complete Health lists Q2055 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS Q2055?

There are 9 tracked policy changes affecting HCPCS Q2055, including updates from Independence Blue Cross, Humana, CareSource. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS Q2055?

Payers that have issued tracked updates for HCPCS Q2055 include: Independence Blue Cross, Humana, CareSource, Aetna.

How do I get notified when HCPCS Q2055 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS Q2055. 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 HCPCS Q2055?

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.

See every payer rule for Q2055

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for Q2055 in one place.

See every payer rule

All billing codes J3590 C9399 J3490 99215 99213 99202

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MA08.190, Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma®

Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage (Revised)

08.02.50, Chimeric Antigen Receptor Therapy (CART): Carvykti® & Abecma®​

[Ohio] Audaire Health Provider Portal

Chimeric Antigen Receptor (CAR) T-cell Therapy - Medicare Advantage (Revised)

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

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

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

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

Prior authorization required

Prior authorization required

Prior authorization required

Does Aetna require prior authorization for Q2055?

Does Ambetter require prior authorization for Q2055?

Does AmeriHealth Caritas require prior authorization for Q2055?

Does Anthem BCBS require prior authorization for Q2055?

Does Arizona Complete Health require prior authorization for Q2055?

What insurance policy changes affect HCPCS Q2055?

Which payers have updated policy for HCPCS Q2055?

How do I get notified when HCPCS Q2055 policy changes?

Why do payers change policies for HCPCS Q2055?

08.02.50, Chimeric Antigen Receptor Therapy (CART): Carvykti® & Abecma®