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 · Coverage · Medical Policy · Infectious Disease, OB-GYN, Pediatrics +2 moreMedium impact

Immune Globulins for Post-Exposure Prophylaxis (CPB 0544, reviewed 2026-10-07)

Effective date
Not stated in the notice
Identified
Oct 10, 2026

Summary

Aetna considers immune globulins medically necessary for hepatitis B, cytomegalovirus, Rho-D, rabies, varicella zoster, tetanus, vaccinia, botulism, hepatitis A, measles (rubeola) and rubella exposures or conditions, and considers all other indications experimental, investigational, or unproven. Each product has its own initial criteria, such as hepatitis B immune globulin for members who had contact with an individual diagnosed with hepatitis B virus, Rho-D immune globulin for unsensitized Rh-negative women at 24 to 28 weeks gestation unless the father is known to be Rh-negative, and varicella zoster immune globulin for high-risk individuals with significant exposure to varicella. Continuation of therapy for each product is considered medically necessary for all members, including new members, who meet all initial medical necessity criteria.

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 · 7 steps
01Precertification of immune globulin human intramuscular injection (IGIM) (GamaSTAN) is required of all Aetna participating providers and members in applicable plan designs.
02For that precertification, call (866) 752-7021 for commercial plans or fax (888) 267-3277, and see the Statement of Medical Necessity forms under Specialty Pharmacy Precertification.
03Continuation of therapy for each product is considered medically necessary for all members, including new members, who meet all initial medical necessity criteria.
04For varicella zoster immune globulin, post-exposure prophylaxis is considered medically necessary as soon as possible within 10 days after exposure to a person with varicella or shingles.
05Hepatitis B immune globulin is listed as not covered for prevention of mother-to-child transmission of hepatitis B virus during pregnancy.
06Codes B15.0 and B15.9 are listed as not covered for hepatitis A indications, and codes B16.0 through B16.9, B18.0 through B18.1 and B19.10 through B19.11 are listed as not covered for hepatitis B indications.
07Treatment of work-related injuries is excluded from coverage under some benefit plans, so check the benefit plan description.

Codes mentioned

9028190399903719029190384903859038690375903769037790396903899039390288J1460J1560J1571J1573J0850J2788J2790J2791J2792J1670Z20.5Z20.6Z20.828Z20.3Z20.4Z20.820Z20.89Z21Z23Z29.89Z48.23Z57.8Z94.4Z16.33Z31.82Z67.11Z67.21Z67.31Z67.41Z67.91B20D89.811P07.00P07.01P07.02P07.03D69.3O02.1P35.1A33A34A35M72.6A48.51B04B97.35B15.0B15.9B18.0B18.1D80.2C88.00C88.01Z86.19

Original notice

Immune Globulins for Post-Exposure Prophylaxis (CPB 0544, reviewed 2026-10-07)
aetna.com · Always check the source before changing claims.
View original ↗

Related policy hubs

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.

Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account