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Adoptive Immunotherapy and Cellular Therapy (CPB 0641, reviewed 2025-10-01)

Aetna·Oncology, Hematology, Infectious Disease +5 more·Medical Policy
Effective date
Oct 1, 2025
We identified it
Aug 12, 2026
Days to comply

Summary

Aetna's updated CPB 0641 (effective 2025-10-01) designates adoptive immunotherapy, cellular therapy, CAR T-cell therapy for solid tumors, and virus-specific T-cell lymphocyte therapy as experimental/investigational/unproven for a broad list of indications. Billing teams must deny claims for these therapies when billed with the specified ICD-10 diagnosis codes. Specific HCPCS codes (S2107, M0075) and related CPT codes used for these therapies will not be covered for listed indications.

Action Required

Action needed
By October 1, 2025: (1) Billing team must configure system edits to deny claims for CPT codes 36511, 86357, 88230, 88237, 88239 and HCPCS codes S2107 and M0075 when paired with any ICD-10 diagnosis codes listed in the policy (A00.0–B99.9, C00.0–D09.9, E85.0–E85.9, G30.0–G30.9, G72.41 for adoptive immunotherapy; B20, B25.9–B34.9, C00.0–D09.9, E08.00–E13.9, G10, G12.20–G12.29, I10–I16.9, I20.1–I20.9, I21.01–I22.9, I24.0–I25.9, I42.8, I50.1–I50.9, I63.50–I63.9, I70.0–I70.92, I73.00–I73.9, I74.2–I74.4, I75.011–I75.029, I80.00–I80.209, I82.401–I82.5Z9, I99.9, J45.20–J45.998, K57.00–K57.93, M00.00–M99.9, N18.1–N18.9, N46.01, N46.021–N46.029, P27.1, R53.82, S06.0X0A–S06.A1XS, U07.1, Z94.0 for cellular therapy; and A08.0–A08.8, A80–A89, A90–A98, B00–B09, B10.01–B10.89, B15–B19, B20, B25–B34, B97.0–B97.8 for virus-specific T-cell lymphocyte therapy). (2) Providers must be notified that these therapies are non-covered for the listed indications; update provider communications and billing guidance documents. (3) Update denial reason codes in billing system to reference CPB 0641. (4) Front desk staff should flag requests for these services during registration to alert providers and billing staff. Claims submitted without prior awareness will be denied at adjudication; proactive system configuration will prevent unnecessary claim submission and rework.

Affected Billing Codes

36511
86357
88230
88237
88239
S2107
M0075