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Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2026-11-02)
Effective date
Not stated in the notice
Identified
Nov 3, 2026
Previous versions
- Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2025-12-19) · published Dec 19, 2025
Summary
Aetna's Clinical Policy Bulletin 0992 (reviewed 2026-11-02) establishes coverage criteria for idecabtagene vicleucel (Abecma), a CAR-T cell therapy for relapsed or refractory multiple myeloma and three rare plasma cell disorders (POEMS, MIDD, MGRS). The policy requires precertification for all covered indications and specifies detailed clinical eligibility criteria, including prior treatment requirements, performance status, organ function, and exclusions for CNS involvement and active infections. All other indications are considered experimental and not covered.
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What to do
Action · 5 steps
01Billing team must obtain precertification from National Medical Excellence (NME) at 877-212-8811 before submitting claims for idecabtagene vicleucel (Abecma) for any Aetna commercial plan member.
02Precertification is required of all participating providers and members in applicable plan designs.
03In charge entry and claim edits, ensure claims include the appropriate diagnosis codes (C90.00–C90.02 for multiple myeloma; D47.2 for MGRS; D47.Z9 for MIDD; or other specified ICD-10 codes for POEMS syndrome) and procedure codes (Q2055 for the therapeutic dose, or 38225–38228 for component harvesting, preparation, and administration).
04Do not submit claims for Abecma for solid tumors or any indication outside the covered list, as claims without precertification or for experimental/investigational uses will be denied.
05Tell providers and front desk staff that this therapy requires dedicated GCIT team review and must be precertified before the member is scheduled for leukapheresis or treatment.
Codes mentioned
382253822638227382289641396414964159641696417Q2055J9041J9046J9047J9048J9049J9051J9054J9144J9145J9227C90.00C90.01C90.02C90.10D47.2D47.Z9
Original notice
Idecabtagene Vicleucel (Abecma) (CPB 0992, reviewed 2026-11-02)
aetna.com · Always check the source before changing claims.
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