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AetnaCommercial · Coverage · Medical Policy · Hematology, OncologyMedium impact

Tafasitamab-cxix (Monjuvi) (CPB 0979, reviewed 2025-11-04)

Effective date
Not stated in the notice
Identified
Aug 17, 2026

Summary

Aetna considers tafasitamab-cxix (Monjuvi) medically necessary for commercial medical plans for relapsed or refractory follicular lymphoma when used with lenalidomide and rituximab for up to a maximum of 12 cycles. For other B-cell lymphomas, it is medically necessary in combination with lenalidomide for up to 12 cycles when the member has HIV-related B-cell lymphoma, histologic transformation of indolent lymphoma to DLBCL without eligibility for an autologous stem cell transplant, monomorphic post-transplant lymphoproliferative disorder (B-cell type), DLBCL, or high-grade B-cell lymphoma. Aetna considers all other indications experimental, investigational, or unproven.

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What to do

Action · 7 steps
01Billing team: obtain precertification for Monjuvi for members in applicable plan designs.
02The source gives the precertification phone number (866) 752-7021 and fax number (888) 267-3277.
03Bill HCPCS J9349 (tafasitamab-cxix, 2 mg) only when the selection criteria are met, and pair it with the ICD-10 codes in the policy that are covered when the criteria are met, such as C82.00 to C82.9A for follicular lymphoma and C83.30 to C83.3A for diffuse large B-cell lymphoma.
04Diagnosis code Z94.84 (stem cells transplant status) is listed as not covered if the selection criteria are met.
05Related intravenous chemotherapy administration CPT codes 96413 to 96417 are listed with this policy.
06Continuation requests for follicular lymphoma need documentation that there is no evidence of unacceptable toxicity or disease progression on the current regimen and that the member has not exceeded 12 cycles.
07For other B-cell lymphomas, after 12 completed cycles the requested drug is used as monotherapy and continuation requires the same no-toxicity, no-progression evidence.

Codes mentioned

J9349Q5115Q5119Q51239641396417C82.00C82.9AC83.30C83.3AC83.80C83.89C85.10C85.19D47.Z1Z94.84

Original notice

Tafasitamab-cxix (Monjuvi) (CPB 0979, reviewed 2025-11-04)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesHematologyOncologyCode J9349Code Q5115Code Q5119Code Q5123Code 96413Code 96417Code C82.00Code C82.9ACode C83.30Code C83.3ACode C83.80Code C83.89Code C85.10Code C85.19Code D47.Z1Code Z94.84

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