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AetnaAll Plans · Coverage · Medical Policy · OncologyMedium impact

Eribulin Mesylate (Halaven) (CPB 0831, reviewed 2026-06-19)

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

Summary

Aetna covers eribulin mesylate (Halaven) as single-agent therapy for recurrent unresectable or metastatic breast cancer when the disease is HER2-negative, or in combination with margetuximab-cmkb or trastuzumab for HER2-positive disease as fourth line therapy and beyond. Single-agent use is also covered for dedifferentiated liposarcoma with or without concurrent well-differentiated liposarcoma, epithelioid hemangioendothelioma, extremity/body wall or head/neck, pleomorphic rhabdomyosarcoma, and retroperitoneal/intra-abdominal soft tissue sarcoma. Continuation of therapy is covered when there is no evidence of unacceptable toxicity or disease progression on the current regimen, and all other indications are considered experimental, investigational, or unproven.

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What to do

Action · 5 steps
01Billing team: Bill HCPCS J9179 (injection, eribulin mesylate, 0.1 mg) and CPT 96409 only for the covered indications, and confirm the diagnosis is one of the covered ICD-10 codes: C48.0 through C48.8, C49.0 through C49.9, C49.A0 through C49.A9, C50.011 through C50.A2 for recurrent or metastatic breast cancer, and D18.00 through D18.09 for epithelioid hemangioendothelioma.
02Confirm the request meets the stated criteria for the indication, including single-agent use for HER2-negative disease, or use with margetuximab-cmkb or trastuzumab as fourth line therapy and beyond for HER2-positive disease.
03For continuation of therapy, confirm there is no evidence of unacceptable toxicity or disease progression on the current regimen.
04Follow the policy dosing of 1.4 mg/m2 intravenously over 2 to 5 minutes on days 1 and 8 of a 21-day cycle, with 1.1 mg/m2 for Child-Pugh A or for creatinine clearance of 15-49 mL/min, and 0.7 mg/m2 for Child-Pugh B.
05Other indications are considered experimental, investigational, or unproven under this policy.

Codes mentioned

96409J9179C48.0C48.8C49.0C49.9C49.A0C49.A9C50.011C50.A2D18.00D18.09

Original notice

Eribulin Mesylate (Halaven) (CPB 0831, reviewed 2026-06-19)
aetna.com · Always check the source before changing claims.
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