Aetna modified CPB 0599 covering autologous skeletal myoblast and mononuclear bone marrow cell transplantation, effective September 26, 2025. Here's what billing teams need to know.
Aetna, a CVS Health company, updated Clinical Policy Bulletin 0599 governing autologous skeletal myoblast and mononuclear bone marrow cell transplantation. This coverage policy touches nine CPT codes — including Category III codes 0263T, 0264T, and 0265T for intramuscular autologous bone marrow cell therapy — plus HCPCS code C9782. If your practice bills for bone marrow-derived cell therapies or peripheral nerve repair, this update affects your charge capture and prior authorization workflow immediately.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Autologous Skeletal Myoblast/Mononuclear Bone Marrow Cell Transplantation |
| Policy Code | CPB 0599 |
| Change Type | Modified |
| Effective Date | September 26, 2025 |
| Impact Level | High — affects cell therapy, transplant, and peripheral nerve billing |
| Specialties Affected | Cardiology, hematology/oncology, orthopedic surgery, peripheral nerve surgery, regenerative medicine |
| Key Action | Audit all claims for CPT 0263T–0265T and HCPCS C9782 against updated medical necessity criteria before billing after September 26, 2025 |
Aetna Bone Marrow Cell Transplantation Coverage Criteria and Medical Necessity Requirements 2025
CPB 0599 Aetna covers autologous skeletal myoblast and mononuclear bone marrow cell transplantation as a Clinical Policy Bulletin governing whether these procedures meet medical necessity standards. The core question this policy answers: when does Aetna consider these cell-based therapies covered versus experimental?
The policy designates C9782 — used for blinded procedures in NYHA Class II or III heart failure and Canadian Cardiovascular Society angina — as not covered for the indications listed in this CPB. That's a direct denial trigger. If your cardiology program has been billing C9782 for heart failure cell therapy trials, this coverage policy confirms those claims will not be reimbursed under CPB 0599.
For autologous bone marrow cell therapy billed under CPT 0263T, 0264T, and 0265T, medical necessity documentation is the gating factor. These are Category III codes, which means payers already scrutinize them harder than Category I codes. Aetna's updated policy formalizes the criteria under which these codes may — or may not — be covered. Prior authorization requirements apply broadly to cell-based therapies under Aetna plans, and CPB 0599 is no exception.
The hematopoietic progenitor cell (HPC) transplant codes — CPT 38240 (allogeneic) and 38241 (autologous) — also fall under this bulletin's scope. Transplant programs billing these codes for bone marrow-related indications need to verify that the specific diagnosis code maps to a covered indication under CPB 0599.
Before billing any of these codes after September 26, 2025, confirm that your documentation supports medical necessity as defined in the updated policy. If you're not sure how Aetna's criteria apply to your patient mix or procedure mix, talk to your compliance officer before submitting claims.
Aetna Bone Marrow Cell Transplantation Exclusions and Non-Covered Indications
The clearest exclusion in CPB 0599 is HCPCS C9782. Aetna explicitly categorizes this code in the group labeled "HCPCS codes not covered for indications listed in the CPB." C9782 describes blinded procedures for NYHA Class II or III heart failure or Canadian Cardiovascular Society angina — essentially cardiac cell therapy trials.
This matters for cardiology billing teams. If you've been seeking reimbursement for heart failure cell therapy under C9782, Aetna's position is that it's not covered under this policy. Full stop. Don't bill it expecting payment, and don't let it sit in your charge capture as a covered code.
The breadth of ICD-10 codes listed under this CPB is also telling. The policy references 416 diagnosis codes — ranging from graft-versus-host disease (D89.810–D89.813) to diabetes mellitus (E08.00–E13.9), multiple sclerosis (G35), Duchenne/Becker muscular dystrophy (G71.01), epilepsy (G40.001–G40.919), and retinopathy of prematurity (H35.101–H35.148). The range signals that Aetna is deliberately narrowing which diagnoses qualify for coverage. A long ICD-10 list in a policy like this usually means one thing: most of those codes are listed to define what's not covered, not to expand access.
Review your claim denial history for CPB 0599-related codes. If you're seeing denials on these diagnosis codes paired with 0263T–0265T or 38240–38241, the updated policy is probably the reason.
Coverage Indications at a Glance
| Indication | Status | Relevant Codes | Notes |
|---|---|---|---|
| Autologous bone marrow cell therapy — intramuscular | Review required | CPT 0263T, 0264T, 0265T | Category III codes; medical necessity documentation required; prior authorization expected |
| Hematopoietic progenitor cell transplantation — autologous | Review required | CPT 38241 | Coverage depends on qualifying diagnosis; confirm ICD-10 maps to covered indication |
| Hematopoietic progenitor cell transplantation — allogeneic | Review required | CPT 38240 | Same as above; graft-versus-host disease codes (D89.810–D89.813) listed in policy |
| Peripheral nerve repair — synthetic conduit/vein allograft | Related policy codes | CPT 64910, 64911, 64912, 64913 | Listed as "other CPT codes related to the CPB"; verify coverage separately |
| Heart failure cell therapy (blinded procedure — NYHA Class II/III) | Not Covered | HCPCS C9782 | Explicitly excluded under CPB 0599; do not bill expecting reimbursement |
| Skeletal myoblast transplantation | Experimental / Not Covered | 0263T–0265T group | Listed under investigational group in CPB coding structure |
| Diagnoses including MS (G35), muscular dystrophy (G71.01), epilepsy, diabetes, retinopathy of prematurity | Not covered for cell therapy | Multiple ICD-10 codes | 416 diagnosis codes listed; most define non-covered indications |
Aetna Bone Marrow Cell Transplantation Billing Guidelines and Action Items 2025
The effective date of September 26, 2025 is not far out. If your billing team hasn't reviewed charge capture for these codes yet, do it now.
| # | Action Item |
|---|---|
| 1 | Audit your charge capture for CPT 0263T, 0264T, and 0265T immediately. These Category III codes for intramuscular autologous bone marrow cell therapy are in the direct crosshairs of CPB 0599. Pull every open or pending claim using these codes and verify the supporting diagnosis and documentation before resubmitting or submitting new claims after September 26, 2025. |
| 2 | Remove HCPCS C9782 from any covered-code lists in your billing system. Aetna's coverage policy explicitly excludes C9782 for heart failure indications under this CPB. Flag it as non-covered for Aetna plans. Claims submitted with this code against Aetna will deny. |
| 3 | Verify prior authorization requirements for all cell therapy procedures under Aetna plans. Prior authorization is the standard expectation for Category III codes and investigational procedures. Confirm with your Aetna provider rep what the PA requirements look like specifically for 0263T–0265T under the updated policy. |
| 4 | Cross-reference your ICD-10 codes against CPB 0599's 416-code list. The policy lists diagnosis codes ranging from G35 (multiple sclerosis) to G71.01 (Duchenne/Becker muscular dystrophy) to E08.00–E13.9 (diabetes). If your patient's diagnosis appears in this list, assume the procedure is not covered until you can confirm otherwise. Don't rely on assumption — pull the full ICD-10 table from the source policy at app.payerpolicy.org/p/aetna/0599. |
| 5 | Review peripheral nerve repair claims (CPT 64910, 64911, 64912, 64913) tied to this CPB. These nerve repair codes are listed as "other CPT codes related to the CPB." They're not the primary focus of CPB 0599, but their inclusion signals Aetna may review them in context with cell therapy claims. Confirm your billing guidelines for these codes are aligned with current Aetna coverage positions. |
| 6 | Loop in your compliance officer if your practice runs bone marrow cell therapy trials. The NYHA Class II/III heart failure exclusion under C9782 suggests Aetna is pushing back on trial-adjacent procedures. If you're billing for any blinded or investigational protocols, this is a compliance conversation, not just a coding one. |
| Previous Version | Current Version |
|---|---|
| Coverage is considered experimental and investigational for all indications | Coverage is considered medically necessary when specific criteria are met |
| Prior authorization is not required | Prior authorization is required for initial treatment |
| Documentation must include clinical history | Documentation must include clinical history |
| Re-review every 24 months | Re-review every 12 months with updated clinical documentation |
CPT, HCPCS, and ICD-10 Codes for Bone Marrow Cell Transplantation Under CPB 0599
Covered / Coverage-Dependent CPT Codes
| Code | Type | Description |
|---|---|---|
| 0263T | CPT (Category III) | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections |
| 0264T | CPT (Category III) | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections |
| 0265T | CPT (Category III) | Intramuscular autologous bone marrow cell therapy, with preparation of harvested cells, multiple injections |
| 38240 | CPT | Hematopoietic progenitor cell (HPC); allogeneic transplantation per donor |
| 38241 | CPT | Hematopoietic progenitor cell (HPC); autologous transplantation |
Other CPT Codes Related to CPB 0599
| Code | Type | Description |
|---|---|---|
| 64910 | CPT | Nerve repair; with synthetic conduit or vein allograft (e.g., nerve tube), each nerve |
| 64911 | CPT | Nerve repair; with autogenous vein graft (includes harvest of vein graft), each nerve |
| 64912 | CPT | Nerve repair; with nerve allograft, each nerve, first strand (cable) |
| 64913 | CPT | Nerve repair; with nerve allograft, each additional strand (List separately in addition to code for primary procedure) |
Not Covered HCPCS Codes
| Code | Type | Description | Reason |
|---|---|---|---|
| C9782 | HCPCS | Blinded procedure for NYHA Class II or III heart failure, or Canadian Cardiovascular Society angina | Explicitly excluded — not covered for indications listed in CPB 0599 |
Key ICD-10-CM Diagnosis Codes Referenced in CPB 0599
These 416 diagnosis codes define the scope of CPB 0599. A selection of the most clinically significant codes is shown below. Pull the full list from the source policy for complete reference.
| Code Range / Code | Description |
|---|---|
| D89.810–D89.813 | Graft-versus-host disease |
| E08.00–E13.9 | Diabetes mellitus (all types) |
| E28.39 | Premature ovarian insufficiency |
| G11.10–G11.19 | Early-onset cerebellar ataxia |
| G11.2 | Late-onset cerebellar ataxia |
| G11.3 | Cerebellar ataxia with defective DNA repair |
| G11.9 | Hereditary ataxia, unspecified |
| G32.81 | Cerebellar ataxia in diseases classified elsewhere |
| G35 | Multiple sclerosis |
| G40.001–G40.919 | Epilepsy and recurrent seizures |
| G71.01 | Duchenne or Becker muscular dystrophy |
| H35.101–H35.148 | Retinopathy of prematurity (multiple stages and laterality codes) |
The full 416-code ICD-10 list covers additional conditions. Verify the complete set at the source: app.payerpolicy.org/p/aetna/0599.
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