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Hematopoietic Colony-Stimulating Factors (CSFs) (CPB 0055, reviewed 2026-07-16)

Aetna·Oncology, Hematology, Critical Care +1 more·Medical Policy
Effective date
Jul 16, 2026
We identified it
Aug 15, 2026
Days to comply

Summary

Aetna updated its Hematopoietic Colony-Stimulating Factors (CSFs) policy (CPB 0055) effective 2026-07-16, establishing new precertification requirements for long-acting and short-acting G-CSF products, clarifying medical necessity criteria for cancer-related neutropenia prevention/treatment, and specifying approved indications including CAR T-cell toxicities and radiation-induced myelosuppression. Billing teams must implement mandatory prior authorization workflows for 16 named G-CSF medications before submitting claims.

Action Required

Action needed
By 2026-07-16: Billing team must implement mandatory precertification workflow for all Aetna commercial plans before submitting any claims for the following medications: Armlupeg, Fulphila, Fylnetra, Neulasta, Nyvepria, Rolvedon, Ryzneuta, Stimufend, Udenyca, Ziextenzo (long-acting G-CSFs); Neupogen, Filkri, Nivestym, Nypozi, Releuko, Zarxio (short-acting G-CSFs); Granix; and Leukine. Update billing system to BLOCK claim submission without prior authorization. Providers must submit precertification requests to Aetna at (866) 752-7021 or fax (888) 267-3277 before administering medication. Front desk staff must add precertification checklist to encounter forms. Claims submitted without precertification approval will be denied. Update encounter templates to document: (1) chemotherapy regimen and FN risk percentage, (2) patient risk factors if applicable, (3) whether this is primary or secondary prophylaxis or febrile neutropenia treatment, and (4) confirmation that no other CSFs are being used in the same cycle. Train billing staff to verify that requested medication meets ONE of the three FN risk tier criteria or falls under approved "Other Indications" (acute myeloid leukemia, agranulocytosis, aplastic anemia, CAR T-cell toxicities, chronic myeloid leukemia, glycogen storage disease type 1, hairy cell leukemia, acute radiation syndrome, myelodysplastic syndrome, HIV/AIDS-related neutropenia, renal transplant neutropenia, severe chronic neutropenia, or stem cell transplantation).

Affected Billing Codes

J2505
J2506
J2507
J2510
J2511
J2515
J2820
J3488