96401 Insurance Policy Changes

Azacitidine (CPB 0960, reviewed 2026-06-12)

Aetna updated its Clinical Policy Bulletin for Azacitidine (CPB 0960) effective June 12, 2026, clarifying coverage criteria for multiple hematologic and oncologic malignancies. The policy specifies approved indications including MDS, AML, MDS/MPN overlap syndromes, and peripheral T-cell lymphoma (PTCL) as single-agent subsequent therapy for relapsed/refractory disease, along with dosing requirements and continuation criteria. Billing teams must ensure claims match these specific indications and document medical necessity for off-label uses, which remain experimental.