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AetnaCommercial · Coverage · Medical Policy · OncologyMedium impact

Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-10-26)

Effective date
Not stated in the notice
Identified
Nov 3, 2026

Previous versions

Summary

Aetna's clinical policy bulletin on ipilimumab (Yervoy), CPB 0815, was reviewed on 2026-10-26. It lists the cancers where Aetna considers the drug medically necessary, mostly in combination with nivolumab, the limits on continued treatment, and the uses Aetna treats as experimental. The text does not state a new effective date or a specific coverage change.

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What to do

Action · 5 steps
01No effective date is stated in the bulletin, so confirm current applicability with Aetna before acting on it.
02Billing team: before scheduling ipilimumab (J9228) for an Aetna commercial member, confirm precertification is on file.
03The bulletin gives the Aetna precertification line as (866) 752-7021, and it says Aetna's Site of Care policy applies, so check the site of care before scheduling.
04In charge entry, confirm the diagnosis matches one of the covered indications and that the nivolumab combination is documented where the indication requires it.
05Tell providers and front desk staff that Aetna lists uses such as glioblastoma, pancreatic cancer, prostate cancer, and combinations with bevacizumab, vemurafenib, dabrafenib or trametinib as experimental, so these should be discussed with the ordering provider before scheduling.

Codes mentioned

81210813018834288341964139641596417J9228J9035J9206J9263J9271J9299Q5107

Original notice

Ipilimumab (Yervoy) (CPB 0815, reviewed 2026-10-26)
aetna.com · Always check the source before changing claims.
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Related policy hubs

Aetna policiesOncologyCode 81210Code 81301Code 88342Code 88341Code 96413Code 96415Code 96417Code J9228Code J9035Code J9206Code J9263Code J9271Code J9299Code Q5107

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