Aldesleukin (Proleukin) — CPB 0024 | AETNA Coverage Update

Aetna modified CPB 0024 for aldesleukin (Proleukin), effective December 11, 2025. Here's what billing teams need to know before submitting claims.

Aetna, a CVS Health company, updated its aldesleukin coverage policy under CPB 0024 Aetna system to add a new covered indication tied to Amtagvi (lifileucel), an FDA-approved tumor-infiltrating lymphocyte therapy. The primary billing code affected is J9015 (injection, aldesleukin, per single use vial), administered via intravenous infusion codes 96413–96417. If your oncology billing team handles metastatic melanoma cases, this change directly affects your claim submission process.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna
Policy	Aldesleukin (Proleukin) — CPB 0024
Policy Code	CPB 0024
Change Type	Modified
Effective Date	December 11, 2025
Impact Level	High
Specialties Affected	Oncology, Hematology/Oncology, Pediatric Oncology, Transplant Medicine
Key Action	Update workflows to capture Amtagvi sequencing for metastatic melanoma claims using J9015 before billing aldesleukin post-Amtagvi infusion

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Aetna Aldesleukin Coverage Criteria and Medical Necessity Requirements 2025

The core of this coverage policy change is a new sub-indication under metastatic cutaneous melanoma. Aetna now covers aldesleukin intravenous administration for up to six doses following Amtagvi (lifileucel) infusion, for unresectable or metastatic cutaneous melanoma. This is a meaningful expansion — and it comes with a specific dose ceiling you need to document.

Before this update, melanoma coverage under CPB 0024 was limited to high-dose single-agent subsequent therapy for metastatic or unresectable disease. That criterion still stands. The new Amtagvi-sequencing indication runs alongside it, not in place of it. You now have two distinct pathways for melanoma coverage under this policy.

For initial approval, Aetna considers aldesleukin intravenous medically necessary for four conditions:

The Amtagvi sequencing criterion is the change that drove this update. Amtagvi does not yet have a dedicated HCPCS code. The policy groups a cluster of corticosteroid HCPCS codes (J0702, J1020, J1030, J1040, J1094, J1100, J1700, J1710, J1720, J2650, J2920, J2930, J3300, J3301, J3302, J3303, J7509, J7510, J7512, J8540) under an "Amtagvi – no specific code" designation, indicating no dedicated Amtagvi billing code exists within this policy. The clinical role of these codes in the Amtagvi context is not defined in the policy text. That's notable for billing: if your team needs to document the Amtagvi infusion that precedes aldesleukin, there is no specific Amtagvi code to anchor the claim sequence. Work with your billing consultant to establish consistent documentation practices before the effective date of December 11, 2025.

Prior authorization workflows for specialty oncology drugs are common with Aetna — confirm PA requirements directly with Aetna for each patient case, as CPB 0024 does not specify PA requirements within the policy text. Given the new sequencing requirement — aldesleukin after Amtagvi — expect reviewers to look for documentation confirming Amtagvi was administered before the aldesleukin course. Build that into your auth requests now.

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Aetna Aldesleukin Continuation of Therapy Requirements 2025

Continuation criteria differ by indication, and these details drive claim denials at the second and third courses of therapy. Know these before you bill.

For renal cell carcinoma and cutaneous melanoma (single-agent subsequent treatment):

• Evaluate the member for response approximately four weeks after completing a course
• Evaluate again immediately before the next treatment course begins
• Only continue if there is some tumor shrinkage after the last course
• Retreatment must not be contraindicated
• Separate each treatment course by at least seven weeks from the date of hospital discharge

These are Aetna's exact criteria. "Some tumor shrinkage" is the standard — not complete response, not stable disease. Document partial response specifically. A claim for a second course without documented tumor shrinkage will not survive a medical necessity review.

For chronic GVHD: Continuation requires symptom improvement and no unacceptable toxicity. Straightforward — but your notes need to capture both elements explicitly.

For neuroblastoma: Continuation is covered when there is no evidence of unacceptable toxicity or disease progression on the current regimen.

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Aetna Aldesleukin Exclusions and Non-Covered Indications

Aetna considers all indications for aldesleukin outside the four listed above as experimental, investigational, or unproven. That's a broad exclusion. Any off-label use — bladder cancer, colorectal cancer, HIV, or other immune-modulating applications — will not meet medical necessity under this coverage policy.

Two HCPCS codes appear on the "not covered" list regardless of selection criteria: J0480 (basiliximab, 20 mg) and J7513 (daclizumab, parenteral, 25 mg). These are IL-2 receptor antagonists sometimes used in combination protocols or GVHD management. Aetna is drawing a clear line — those drugs don't get coverage under CPB 0024, even when aldesleukin itself is approved.

Subcutaneous and intramuscular chemotherapy administration codes 96401 and 96402 are also explicitly not covered for the indications listed in this policy. Aldesleukin must be administered intravenously to meet these criteria. If you see a claim for subcutaneous aldesleukin administration under this policy, it will deny.

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Coverage Indications at a Glance

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Aetna Aldesleukin Billing Guidelines and Action Items 2025

Copy Action Items

If your team handles a high volume of melanoma or renal cell carcinoma cases billed to Aetna, run an audit of your current aldesleukin claims before December 11, 2025. Compare your documentation practices against the continuation criteria above. If anything is unclear about how this applies to your patient mix, talk to your compliance officer before the effective date.

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CPT, HCPCS, and ICD-10 Codes for Aldesleukin (Proleukin) Under CPB 0024

Covered HCPCS Code (When Selection Criteria Are Met)

Code	Type	Description Copy
J9015	HCPCS	Injection, aldesleukin, per single use vial

CPT Codes — Not Covered for Indications Listed in CPB 0024

Code	Type	Description Copy
96401	CPT	Chemotherapy administration, subcutaneous or intramuscular
96402	CPT	Chemotherapy administration, subcutaneous or intramuscular

CPT Codes — Other Codes Related to CPB 0024

HCPCS Codes — Not Covered Under CPB 0024

Code	Type	Description Copy
J0480	HCPCS	Injection, basiliximab, 20 mg
J7513	HCPCS	Daclizumab, parenteral, 25 mg

HCPCS Codes — Amtagvi-Related (No Specific Amtagvi Code)

The policy groups these codes under an "Amtagvi – no specific code" designation, indicating no dedicated Amtagvi billing code exists within this policy. The clinical role of these codes in the Amtagvi context is not defined in the policy text.

Key ICD-10-CM Diagnosis Codes

The full ICD-10-CM code set spans 660 codes. Verify specific applicable codes against the full policy document at CPB 0024 on PayerPolicy. The presence of infectious disease codes (A00.0–B99.9) in the code set reflects contraindication documentation — active infections are a basis for denying aldesleukin therapy, not a covered indication.

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