Aetna considers axicabtagene ciloleucel (Yescarta) medically necessary for B-cell lymphoma indications listed in the policy, including DLBCL arising from follicular lymphoma, follicular lymphoma after two or more lines of systemic therapy, marginal zone lymphomas, pediatric primary mediastinal large B-cell lymphoma, and relapsed or refractory primary central nervous system lymphoma as a single agent, when the listed criteria are met. Aetna considers it experimental, investigational, or unproven for acute lymphoblastic leukemia, indolent non-Hodgkin lymphomas other than the listed exceptions, mantle cell lymphoma, and solid tumors, and considers repeat administration experimental, investigational, or unproven. Yescarta requires precertification for all Aetna participating providers and members in applicable plan designs.
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01Billing team: Get precertification before billing axicabtagene ciloleucel (Yescarta) by contacting National Medical Excellence at 1-877-212-8811.
02Confirm the member is not excluded, including prior treatment with Yescarta or another CD19-directed CAR T-cell therapy, ECOG performance status of 3 or higher, inadequate kidney, liver, pulmonary or cardiac function, active hepatitis B or C or other clinically significant active systemic infection, or an active inflammatory disorder.
03Bill HCPCS Q2041 per infusion, and use the related CPT codes 38225, 38226, 38227 and 38228 as listed in the policy.
Summaries are AI-assisted. Always confirm against the original payer notice.
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