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AetnaAll Plans · Coverage · Medical Policy · Oncology, Hematology, OB-GYNMedium impact

Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)

Effective date
Not stated in the notice
Identified
Aug 18, 2026

Summary

Aetna considers temsirolimus (Torisel or generic temsirolimus) medically necessary as a single agent for subsequent treatment of locally advanced, recurrent, or metastatic endometrial carcinoma, for relapsed or refractory mantle cell lymphoma, and for advanced renal cell carcinoma. It also considers it medically necessary for specified soft tissue sarcoma subtypes, for rhabdomyosarcoma (maximum 12 cycles, with cyclophosphamide and vinorelbine), and for subsequent treatment of advanced, recurrent/metastatic, or inoperable PEComa in uterine sarcoma. Aetna considers all other indications experimental, investigational, or unproven, and considers continuation of therapy medically necessary when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

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What to do

Action · 6 steps
01Billing team: Bill J9330 (temsirolimus, 1 mg) only when the selection criteria are met and the diagnosis is one of the covered indications, using the covered ICD-10 codes, such as C54.1 for endometrial carcinoma, C83.10 to C83.19 for mantle cell lymphoma, C64.1 to C65.9 for kidney and renal pelvis cancer, and J84.81 for lymphangioleiomyomatosis.
02For continued treatment, the claim must reflect that there is no evidence of unacceptable toxicity or disease progression while on the current regimen.
03For rhabdomyosarcoma, the policy covers a maximum of 12 cycles in combination with cyclophosphamide and vinorelbine.
04For advanced renal cell carcinoma, the recommended dose is 25 mg as an intravenous infusion over 30 to 60 minutes once a week, until disease progression or unacceptable toxicity.
05The ICD-10 codes listed as not covered for the policy's indications include C10.0 to C10.9, C25.0 to C25.9, C73, and U07.1.
06Aetna considers temsirolimus experimental, investigational, or unproven for all other indications.

Codes mentioned

J9330C49.0C49.9C53.0C54.0C54.1C54.2C55C64.1C65.9C83.10C83.19D49.2J84.81C10.0C10.9C11.0C11.9C22.2C25.0C25.9C57.00C57.02C69.20C69.22C07C73C08.0C08.9C83.30C83.3AC83.80C83.89C85.80C85.89C90.00C90.02C91.00C91.02D09.3D46.0D46.9D48.110D48.19G20.A1G20.CI70.291I70.299U07.1

Original notice

Temsirolimus (Torisel) (CPB 0873, reviewed 2025-10-09)
aetna.com · Always check the source before changing claims.
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Related changes

See all Aetna changes →
Paclitaxel, Albumin-Bound (CPB 0834, reviewed 2026-05-28)MediumNo effective date · Medical PolicyTemsirolimus (Torisel) (CPB 0873, reviewed 2026-10-08)MediumNo effective date · Medical PolicyDostarlimab-gxly (Jemperli) (CPB 0993, reviewed 2026-01-27)MediumNo effective date · Medical PolicyDocetaxel (CPB 0956, reviewed 2026-10-05)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesOncologyHematologyOB-GYNCode J9330Code C49.0Code C49.9Code C53.0Code C54.0Code C54.1Code C54.2Code C55Code C64.1Code C65.9Code C83.10Code C83.19Code D49.2Code J84.81Code C10.0Code C10.9Code C11.0Code C11.9Code C22.2Code C25.0Code C25.9Code C57.00Code C57.02Code C69.20Code C69.22Code C07Code C73Code C08.0Code C08.9Code C83.30Code C83.3ACode C83.80Code C83.89Code C85.80Code C85.89Code C90.00Code C90.02Code C91.00Code C91.02Code D09.3Code D46.0Code D46.9Code D48.110Code D48.19Code G20.A1Code G20.CCode I70.291Code I70.299Code U07.1

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