Donor Lymphocyte Infusion — CPB 0638 | AETNA Coverage Update

Aetna modified CPB 0638 for donor lymphocyte infusion (DLI), effective November 14, 2025. Here's what billing teams need to know before submitting claims under CPT 38242 or any of the covered allogeneic transplant codes in the 38204–38230 series.

Aetna, a CVS Health company, updated CPB 0638 — its clinical policy bulletin governing donor lymphocyte infusion coverage — with a November 14, 2025 effective date. The policy covers CPT 38242 (allogeneic lymphocyte infusions) and a set of bone marrow and stem cell service codes (CPT 38204, 38205, and 38207–38230), plus HCPCS S2150. It also draws hard lines around what it will not cover — and the exclusion list is long enough that your billing team should know it cold before submitting a single DLI claim.

---

Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Donor Lymphocyte Infusion — CPB 0638
Policy Code	CPB 0638
Change Type	Modified
Effective Date	November 14, 2025
Impact Level	High
Specialties Affected	Hematology/Oncology, Bone Marrow Transplant, Stem Cell Transplant, Transfusion Medicine
Key Action	Audit all active DLI claims and verify the patient had a prior, medically necessary allogeneic transplant before billing CPT 38242

---

Aetna Donor Lymphocyte Infusion Coverage Criteria and Medical Necessity Requirements 2025

The Aetna donor lymphocyte infusion coverage policy has a single, non-negotiable threshold for medical necessity: the patient must have already received a prior, medically necessary allogeneic bone marrow or peripheral stem cell transplantation.

That's the whole gate. No prior allogeneic transplant, no covered DLI. There is no exception listed in CPB 0638 for patients who received autologous transplants.

When that criterion is met, Aetna covers DLI services under CPT 38242 — allogeneic lymphocyte infusions — and the bone marrow and stem cell service codes CPT 38204, 38205, and 38207–38230. Note that CPT 38206 is not in the covered code set. HCPCS S2150 (bone marrow or blood-derived stem cells, allogeneic or autologous, harvested) also falls under covered services when selection criteria are met.

One important carve-out: CPT 38242 carries a specific restriction in CPB 0638. Aetna will not cover it for allogeneic CAR donor lymphocyte infusion. That restriction is embedded in the code's description group and should be reflected in your charge capture before submitting any CAR-adjacent DLI claims.

Aetna also references compatibility studies (CPT 86812 through 86822) and therapeutic apheresis for white blood cells (CPT 36511) as related codes. These aren't in the covered-if-criteria-met group — they're flagged as related to the policy. Still, if your team bills these alongside DLI services, confirm documentation supports the connection.

Prior authorization requirements aren't explicitly detailed in the CPB 0638 policy language itself. That doesn't mean prior auth doesn't apply — transplant-related services almost always carry prior auth requirements under commercial plans. Check the member's specific plan benefits before scheduling. Don't assume coverage equals no prior auth.

---

Aetna Donor Lymphocyte Infusion Exclusions and Non-Covered Indications

The exclusion list in CPB 0638 is where your claims are most likely to get denied. Aetna calls the following experimental, investigational, or unproven — and will not reimburse for them.

DLI for multiple myeloma (ICD-10 C90.0–C90.2) is explicitly not covered. This is a significant exclusion given how frequently multiple myeloma follows allogeneic transplant. Patients with C90.x diagnosis codes who receive DLI will face claim denial under this policy.

G-CSF–stimulated DLI — where filgrastim or pegfilgrastim is used to boost the donor lymphocyte yield before infusion — is also excluded. This directly implicates the HCPCS codes Aetna lists as not covered under CPB 0638: J1442 (filgrastim, non-biosimilar), J1447 (tbo-filgrastim), J2505 (pegfilgrastim), C9173 and Q5148 (filgrastim-txid biosimilar), Q5101 (filgrastim biosimilar, Zarxio), Q5108, Q5110, Q5120, and Q5122 (pegfilgrastim biosimilars). If your team bills any of these G-CSF agents in the context of a DLI encounter, Aetna will not cover them for this indication.

Intrathecal DLI is excluded. Standard IV infusion is the covered route. If the clinical team is considering intrathecal delivery, document it separately and don't bill it under CPB 0638 coverage expectations.

Modified donor lymphocytes get a blanket exclusion. This covers a wide range of techniques: donor lymphocyte depletion, ex-vivo expansion, antigen-specific T-cell line expansion, T-cell depletion, chimeric antigen receptor modification, and genetic modification. These approaches are all experimental under this policy. The only carve-out is FDA-approved CAR T therapy (autologous) — but that's governed by CPB 0920 (Tisagenlecleucel/Kymriah) and CPB 0924 (Axicabtagene Ciloleucel/Yescarta), not CPB 0638.

Pre-transplant DLI treated with extracorporeal photochemotherapy for solid organ rejection prevention is excluded. So is reduced-dose DLI for Epstein-Barr virus–related post-transplant lymphoproliferative disease (D47.Z1) after hematopoietic stem cell transplantation.

Donor lymphocyte-derived natural killer cells for melanoma (ICD-10 C43.0–C43.9) rounds out the exclusion list. If your facility is billing NK cell infusions for melanoma patients post-transplant, those claims will not pass under CPB 0638.

---

Coverage Indications at a Glance

---

Aetna Donor Lymphocyte Infusion Billing Guidelines and Action Items 2025

Here's what your billing team should do before submitting DLI claims under CPB 0638.

Copy Action Items

If your facility treats a high volume of post-transplant patients with complex relapsed disease, talk to your compliance officer before the November 14, 2025 effective date to make sure your internal protocols reflect these boundaries.

---

CPT, HCPCS, and ICD-10 Codes for Donor Lymphocyte Infusion Under CPB 0638

Covered CPT Codes (When Selection Criteria Are Met)

Covered HCPCS Codes (When Selection Criteria Are Met)

Code	Type	Description Copy
S2150	HCPCS	Bone marrow or blood-derived stem cells (peripheral or umbilical), allogeneic or autologous, harvested

Not Covered / Experimental HCPCS Codes

Other CPT Codes Related to CPB 0638

Key ICD-10-CM Diagnosis Codes

---