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Docetaxel (CPB 0956, reviewed 2025-12-04)
Effective date
Not stated in the notice
Identified
Aug 13, 2026
Summary
Aetna considers docetaxel (Beizray, Docivyx, Taxotere or generic docetaxel) medically necessary for the cancers listed in the policy, including breast cancer, non-small cell lung cancer, prostate cancer, gastric and esophageal cancers, head and neck cancer, bladder cancer, soft tissue sarcoma, uterine neoplasms and others, and considers continuation medically necessary when there is no evidence of unacceptable toxicity or disease progression on the current regimen. Aetna considers all other indications experimental, investigational or unproven.
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What to do
Action · 6 steps
01Billing team: Bill docetaxel per 1 mg using HCPCS J9171 for docetaxel, J9172 for the ingenus product that is not therapeutically equivalent to J9171, J9174 for Beizray, or J9232 for the Hospira product that is not therapeutically equivalent to J9171.
02Before billing, confirm the member meets the initial criteria for the listed indication.
03For HER2-positive breast cancer, confirm the regimen is one the policy lists (with pertuzumab and trastuzumab, with trastuzumab, adjuvant or preoperative therapy, or as a substitute for other taxanes in select members).
04For HER2-negative breast cancer, confirm the regimen is one the policy lists (single agent or with capecitabine).
05For continuation requests, confirm there is no evidence of unacceptable toxicity or disease progression on the current regimen.
06Indications not on the policy's list are considered experimental, investigational or unproven.
Codes mentioned
J9171J9172J9174J9232C12C44.520C46.2C52C61C73C76.0C80.1
Original notice
Docetaxel (CPB 0956, reviewed 2025-12-04)
aetna.com · Always check the source before changing claims.
Related changes
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