Back to dashboard
CommercialCoverageLow impact

Temsirolimus (Torisel) (CPB 0873, reviewed 2026-10-08)

Aetna·Oncology, Hematology·Medical Policy
Effective date
Not stated
We identified it
Oct 13, 2026
Days to comply
—

Summary

This is a policy review (not a change) of Aetna's Clinical Policy Bulletin 0873 for temsirolimus (Torisel), last reviewed 2026-10-08. The policy defines approved indications (endometrial carcinoma, mantle cell lymphoma, renal cell carcinoma, soft tissue sarcoma, uterine sarcoma, and rhabdomyosarcoma), continuation criteria, dosing, and designates all other indications as experimental/investigational. No policy modifications or effective date changes are stated in the source document.

Action Required

Action needed
No immediate action required. This document is a policy review dated 2026-10-08, not a policy change notice with a stated effective date. Billing and authorization teams should retain this bulletin for reference to confirm current Aetna coverage criteria for temsirolimus requests. Verify applicability by checking whether Aetna has issued a separate, dated change notice that supersedes or modifies this review. Use the approved indications and ICD-10 codes listed to determine prior authorization requirements for claims submitted to Aetna.

Affected Billing Codes

96409
96413
96414
96415
96416
96417
J9330
J9073
J9074
J9075
J9076
J9390
C49.0
C49.1
C49.2
C49.3
C49.4
C49.5
C49.6
C49.8
C49.9
C53.0
C53.1
C53.8
C53.9
C54.0
C54.2
C54.3
C54.8
C54.9
C55
C54.1
C64.1
C64.2
C64.8
C64.9
C65.1
C65.2
C65.8
C65.9
C83.10
C83.11
C83.12
C83.13
C83.14
C83.15
C83.16
C83.17
C83.18
C83.19
D49.2
J84.81