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AetnaCommercial · Prior Auth · Medical Policy · Oncology, HematologyMedium impact

Epcoritamab-bysp (Epkinly) (CPB 1034, reviewed 2026-07-29)

Effective date
Not stated in the notice
Identified
Aug 13, 2026

Summary

Aetna's Clinical Policy Bulletin 1034 covers Epkinly (epcoritamab-bysp), a subcutaneous bispecific antibody, for commercial plans only, for specific relapsed or refractory B-cell lymphomas and Richter transformation, and it requires precertification. Aetna treats all other indications as experimental, and continuation is limited to members with no unacceptable toxicity or disease progression, with a maximum of 12 cycles when used with lenalidomide and rituximab for follicular lymphoma. The source is dated by its review on 2026-07-29 and states no effective date for a change, so the billing team should confirm the current bulletin before the next dose or reauthorization.

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What to do

Action · 5 steps
01No effective date is stated in the source, so there is no source-stated deadline.
02Before the first dose or any reauthorization, front desk staff and billing team should confirm precertification by calling Aetna at (866) 752-7021 or faxing (888) 267-3277.
03Providers should document the lymphoma subtype and the line of therapy that matches one of the criteria in the bulletin, and for reauthorization, document that there is no unacceptable toxicity or disease progression.
04Billing team: in charge entry, report J9321 by 0.16 mg per unit, so each step-up and full dose is billed in the units the dosing schedule requires, and report 96401 for the subcutaneous administration.
05Billing team: track the follicular lymphoma cycles with lenalidomide and rituximab, since the source caps authorization at 12 cycles.

Codes mentioned

96401J9321J9184J9196J9198J9201J9263J9312C88.40C88.41D47.Z1

Original notice

Epcoritamab-bysp (Epkinly) (CPB 1034, reviewed 2026-07-29)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOncologyHematologyCode 96401Code J9321Code J9184Code J9196Code J9198Code J9201Code J9263Code J9312Code C88.40Code C88.41Code D47.Z1

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