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AetnaCommercial · Prior Auth · Medical Policy · OncologyMedium impact

Tarlatamab-dlle (Imdelltra) (CPB 1062, reviewed 2026-08-07)

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

Summary

Aetna considers tarlatamab-dlle (Imdelltra) medically necessary as a single agent for extensive stage small cell lung cancer with disease progression on or after platinum-based chemotherapy, or for treatment of brain metastases in small cell lung cancer. Continuation of therapy is considered medically necessary when there is no evidence of unacceptable toxicity or disease progression while on the current regimen. Aetna considers all other indications experimental, investigational, or unproven.

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What to do

Action · 5 steps
01Billing team: Obtain precertification for tarlatamab-dlle (Imdelltra) by calling (866) 752-7021 or faxing (888) 267-3277, using the Statement of Medical Necessity forms under Specialty Pharmacy Precertification.
02Confirm the member has extensive stage small cell lung cancer with progression on or after platinum-based chemotherapy, or that the drug will be used for brain metastases in small cell lung cancer.
03Bill the drug under HCPCS J9026 (tarlatamab-dlle, 1 mg) and ICD-10 codes C34.00 to C34.92 for extensive stage small cell lung cancer.
04Related CPT codes are 96401 to 96548 for chemotherapy and other highly complex drug or highly complex biologic agent administration.
05Providers: Administer Imdelltra as a 1-hour intravenous infusion and monitor patients from the start of the infusion for 22 to 24 hours on Cycle 1 Day 1 and Cycle 1 Day 8 in an appropriate healthcare setting.

Codes mentioned

J9026C34.00C34.929640196548

Original notice

Tarlatamab-dlle (Imdelltra) (CPB 1062, reviewed 2026-08-07)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOncologyCode J9026Code C34.00Code C34.92Code 96401Code 96548

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