T86.21 Insurance Policy Changes

ICD-10 T86.21 is officially defined as "Heart transplant rejection." code T86.21 is referenced in 4 tracked payer policy changes from Aetna and Blue Cross & Blue Shield of Mississippi. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for code T86.21 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Aetna · Identified Oct 1, 2026Medium impact
Donor Lymphocyte Infusion (CPB 0638, reviewed 2026-09-29)
Aetna considers donor lymphocyte infusion medically necessary for persons who have had a prior medically necessary allogeneic bone marrow or peripheral stem cell transplantation. Several uses are considered experimental, investigational, or unproven, including GCSF-stimulated donor lymphocyte infusions for relapsed disease, intrathecal donor lymphocyte infusion, modified donor lymphocytes, reduced-dose infusion for Epstein-Barr virus-related post-transplant lymphoproliferative disease, pre-transplant infusion of extracorporeal photochemotherapy-treated donor lymphocytes for solid organ transplant, and donor lymphocyte-derived natural killer cells for melanoma. The policy does not apply to FDA-approved chimeric antigen receptor therapy, which is addressed in CPB 0920 and CPB 0924.
Aetna · Identified Aug 14, 2026Medium impact
Donor Lymphocyte Infusion (CPB 0638, reviewed 2025-11-12)
Aetna considers donor lymphocyte infusion (DLI) medically necessary for persons who have had a prior, medically necessary allogeneic bone marrow or peripheral stem cell transplantation. Aetna considers these uses experimental, investigational, or unproven: GCSF-stimulated DLI for relapsed disease after allogeneic hematopoietic cell transplantation, intrathecal DLI, modified donor lymphocytes (such as depleted, expanded, T-cell depleted, CAR-modified or genetically modified cells), pre-transplant infusion of extracorporeal photochemotherapy-treated donor lymphocytes to prevent graft rejection after solid organ transplantation, reduced-dose DLI for Epstein-Barr virus-related post-transplant lymphoproliferative disease, and donor lymphocyte-derived natural killer cells for melanoma. The policy does not apply to FDA-approved CAR T therapy, which involves modification of autologous lymphocytes.
Aetna · Identified Aug 12, 2026Medium impact
Bortezomib Products (CPB 0675, reviewed 2026-02-17)
Aetna Clinical Policy Bulletin 0675, last reviewed 02/17/2026, sets commercial medical coverage criteria for bortezomib (Velcade, Boruzu, or generic bortezomib). Aetna considers bortezomib medically necessary for acute lymphoblastic leukemia, adult T-cell leukemia/lymphoma as a single agent for subsequent therapy, Kaposi sarcoma as subsequent therapy, antibody mediated rejection of solid organ, relapsed or refractory follicular lymphoma, relapsed or refractory pediatric classic Hodgkin lymphoma, mantle cell lymphoma, multicentric Castleman disease as subsequent therapy, multiple myeloma, POEMS syndrome, plasma cell-related MIDD and MGRS, systemic light chain amyloidosis, and Waldenström macroglobulinemia/lymphoplasmacytic lymphoma, and considers all other indications experimental, investigational, or unproven, including acute myeloid leukemia, glioblastoma multiforme, and smoldering (asymptomatic) myeloma. Approvals may be subject to dosing limits, and for all indications dosing does not exceed 1.6 mg/m2 per dose or require more than 7 doses per 30-day period.
Blue Cross & Blue Shield of Mississippi · Identified Jun 20, 2026Medium impact
Extracorporeal Photopheresis
Extracorporeal photopheresis may be considered medically necessary to treat cardiac allograft rejection that is recurrent or refractory to standard immunosuppressive drug treatment, and to treat acute or chronic graft-versus-host disease that is refractory to medical therapy. It may also be considered medically necessary for late-stage (III or IV) cutaneous T-cell lymphoma and for early-stage (I or II) cutaneous T-cell lymphoma that is progressive and refractory to established nonsystemic therapies. Other solid organ rejection uses, graft-versus-host disease that is previously untreated or responding to established therapies, early-stage cutaneous T-cell lymphoma that is untreated or responsive to established nonsystemic therapies, autoimmune diseases, and all other indications are considered investigational.

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FREQUENTLY ASKED QUESTIONS

What insurance policy changes affect code T86.21?

There are 4 tracked policy changes affecting code T86.21, including updates from 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 T86.21?

Payers that have issued tracked updates for code T86.21 include: Aetna, Blue Cross & Blue Shield of Mississippi.

How do I get notified when code T86.21 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to code T86.21. 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 T86.21?

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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Donor Lymphocyte Infusion (CPB 0638, reviewed 2026-09-29)

Donor Lymphocyte Infusion (CPB 0638, reviewed 2025-11-12)

Bortezomib Products (CPB 0675, reviewed 2026-02-17)

Extracorporeal Photopheresis

What insurance policy changes affect code T86.21?

Which payers have updated policy for code T86.21?

How do I get notified when code T86.21 policy changes?

Why do payers change policies for code T86.21?