Obecabtagene Autoleucel (Aucatzyl) (CPB 1072, reviewed 2026-01-27)

Effective immediately (policy dated 2026-01-27): Billing team must implement mandatory precertification requirement for all Aucatzyl claims submitted to Aetna. Contact National Medical Excellence (NME) at 877-212-8811 for all precertification requests before claim submission. Update billing system to flag CPT codes 38225-38228 and HCPCS code Q2058 as requiring precertification for Aetna commercial plans. Front desk and clinical staff must verify patient meets ALL coverage criteria before scheduling: adult age (18+), ECOG performance status <3, CD19-positive disease, adequate organ function, no active infections/inflammatory disorders, and no active graft-versus-host disease. Providers must document bone marrow blast assessment (≥5% blasts) within 7 days prior to lymphodepleting chemotherapy and disease CD19 positivity. Billing staff must verify prior CD19-directed therapy history and confirm patient has not received prior Aucatzyl or other CAR-T therapy (except blinatumomab may have been used). For Philadelphia chromosome-negative disease, confirm relapsed/refractory status per policy criteria. For Philadelphia chromosome-positive disease, verify treatment with ≥2 different TKIs or documented TKI intolerance/contraindication. Claims submitted without precertification or failing to meet eligibility criteria will be denied.