Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
AetnaCommercial · Prior Auth · Medical Policy · Allergy & Immunology, Pulmonology, ENT (Ear, Nose & Throat) +3 moreMedium impact

Omalizumab (CPB 0670, reviewed 2026-08-21)

Effective date
Not stated in the notice
Identified
Sep 29, 2026

Summary

Aetna Clinical Policy Bulletin 0670 sets the coverage criteria for omalizumab (Xolair) and its biosimilar omalizumab-igec (Omlyclo) under commercial medical plans. Covered indications are asthma, chronic rhinosinusitis with nasal polyps, chronic spontaneous urticaria, IgE-mediated food allergy, refractory immune checkpoint inhibitor-related pruritus, and systemic mastocytosis, each with listed criteria such as diagnosis, pre-treatment IgE level, prior therapy and continued positive clinical response. Precertification is required in applicable plan designs and the Site of Care Utilization Management Policy applies, and Aetna considers all other indications, including allergic rhinitis, atopic dermatitis and eosinophilic esophagitis, experimental, investigational or unproven.

Get alerts when payers change rules like this one

We check Aetna and other payers every day and email you when a change matches your specialty and state.

Get Aetna alertsPolicy Monitoring is free. No card required.

What to do

Action · 8 steps
01REQUIREMENTS: Billing team and providers: Before scheduling omalizumab for Aetna commercial members, obtain precertification, which is required of all Aetna participating providers and members in applicable plan designs.
02Call (1) 752-7021 or fax (2) 267-3277 for omalizumab precertification, and use the Statement of Medical Necessity precertification forms where required.
03Confirm that the drug is prescribed by or in consultation with an allergist/immunologist, pulmonologist, otolaryngologist, dermatologist, hematologist or oncologist, depending on the indication.
04Apply the Site of Care Utilization Management Policy to omalizumab products.
05For asthma, obtain a baseline total serum IgE level, which the policy states is medically necessary before treatment, and document a positive skin test or in vitro reactivity to a perennial aeroallergen.
06Continued asthma treatment with inhaled corticosteroids and an additional controller must be documented alongside the requested medication.
07For CRSwNP, document continued daily intranasal corticosteroid use unless contraindicated or not tolerated.
08Confirm the member is not using omalizumab concomitantly with another biologic or targeted synthetic drug for the same indication.

Codes mentioned

J2357Q515495012D47.02L50.8J33.0J33.9J45.40J45.52

Original notice

Omalizumab (CPB 0670, reviewed 2026-08-21)
aetna.com · Always check the source before changing claims.
View original ↗

Related changes

See all Aetna changes →
Omalizumab (CPB 0670, reviewed 2026-06-05)MediumNo effective date · Medical PolicyTezepelumab-ekko (Tezspire) (CPB 1003, reviewed 2026-08-06)MediumNo effective date · Medical PolicyMepolizumab (Nucala) (CPB 0897, reviewed 2026-08-05)MediumNo effective date · Medical PolicyInfrared Therapy (CPB 0604, reviewed 2026-09-09)MediumNo effective date · Medical PolicyBrowse every Aetna change in the policy list

Related policy hubs

Aetna policiesAllergy & ImmunologyPulmonologyENT (Ear, Nose & Throat)DermatologyHematologyOncologyCode J2357Code Q5154Code 95012Code D47.02Code L50.8Code J33.0Code J33.9Code J45.40Code J45.52

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account