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AetnaCommercial · Coverage · Medical Policy · OncologyMedium impact

Bevacizumab for Non-Ocular Indications (CPB 0685, reviewed 2026-04-07)

Effective date
Not stated in the notice
Identified
Aug 12, 2026

Summary

Aetna Clinical Policy Bulletin 0685 covers bevacizumab (Avastin) and its biosimilars for non-ocular indications under commercial medical plans. Aetna considers these products medically necessary for ampullary adenocarcinoma, appendiceal neoplasms and cancers, central nervous system cancers, cervical cancer, colorectal cancer including appendiceal and anal adenocarcinoma, stage III-IV endometrial carcinoma, hepatocellular carcinoma when used with atezolizumab, mesothelioma, non-squamous non-small cell lung cancer, ovarian, fallopian tube and primary peritoneal cancer, relapsed or stage IV renal cell carcinoma, small bowel adenocarcinoma, soft tissue sarcoma, vaginal cancer, and vulvar cancer. Aetna considers all other non-ocular indications as experimental, investigational, or unproven. The policy was last reviewed 04/07/2026.

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What to do

Action · 6 steps
01Get precertification for bevacizumab products (Avastin, Alymsys, Avzivi, Jobevne, Mvasi, Vegzelma, or Zirabev) for oncology indications, which is required of Aetna participating providers in applicable plan designs.
02Precertification can be requested by phone at (866) 752-7021 or by fax at (888) 267-3277, and Statement of Medical Necessity (SMN) precertification forms are used.
03Confirm the indication is one of the listed initial approval indications, and for reauthorization, that there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
04The Site of Care Utilization Management Policy applies to these products, and approvals may be subject to dosing limits in accordance with FDA-approved labeling, accepted compendia, and/or evidence-based practice guidelines.
05Aetna considers bevacizumab with cetuximab or panitumumab, with atezolizumab for renal cell carcinoma, and with pemetrexed as maintenance therapy for non-squamous non-small cell lung cancer experimental, investigational, or unproven.
06Ocular indications are covered under CPB 0701.

Codes mentioned

J9035Q5107Q5118Q5126Q5129Q5160C22.0C22.3C24.1C26.0C38.4C45.0C45.1C45.2C45.7D32.0Q85.02Q85.03

Original notice

Bevacizumab for Non-Ocular Indications (CPB 0685, reviewed 2026-04-07)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOncologyCode J9035Code Q5107Code Q5118Code Q5126Code Q5129Code Q5160Code C22.0Code C22.3Code C24.1Code C26.0Code C38.4Code C45.0Code C45.1Code C45.2Code C45.7Code D32.0Code Q85.02Code Q85.03

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