CommercialCoverageMedium impact
Calaspargase Pegol-mknl (Asparlas) (CPB 0957, reviewed 2025-11-04)
Aetna·Oncology, Pediatrics, Hematology·Medical Policy
Effective date
Oct 30, 2019
We identified it
Aug 12, 2026
Summary
Aetna updated its medical policy for Calaspargase Pegol-mknl (Asparlas) effective October 30, 2019, with a review completed November 4, 2025. The policy establishes coverage criteria for this chemotherapy agent limited to acute lymphoblastic leukemia or lymphoblastic lymphoma in patients age 21 years or younger when used with multi-agent chemotherapy. All other indications remain experimental/investigational. Billing teams must ensure prior authorization is obtained and age/diagnosis criteria are verified before claims submission.
Action Required
Before submitting any Asparlas claims: (1) Billing team must verify patient age is 21 years or younger in the medical record before claim submission. (2) Confirm diagnosis is acute lymphoblastic leukemia (C91.00-C91.02) or lymphoblastic lymphoma (C83.50-C83.59) in the claim. (3) Obtain or verify prior authorization was approved specifically for Asparlas with multi-agent chemotherapy before processing payment. (4) Route claims only when all criteria are met; deny or hold claims for patients over age 21 or with non-covered indications. (5) Use CPT codes 96413-96415 for chemotherapy administration billing only when the underlying drug (Asparlas) meets coverage criteria. Claims submitted without meeting age and diagnosis requirements will be denied.