Plerixafor — CPB 0779 | AETNA Coverage Update

Aetna modified CPB 0779 covering plerixafor (Mozobil) for hematopoietic stem cell mobilization, effective February 14, 2026. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its plerixafor coverage policy under CPB 0779 in the Aetna system on February 14, 2026. The policy governs medical necessity criteria for J2562 (injection, plerixafor, 1 mg), the primary billable HCPCS code for Mozobil and its generic equivalents. If your team bills J2562 alongside G-CSF agents like J1442 (filgrastim) or J2505 (pegfilgrastim) for stem cell mobilization cases, this update defines the boundaries of covered use — and where you'll get denied.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna
Policy	Plerixafor – CPB 0779
Policy Code	CPB 0779
Change Type	Modified
Effective Date	February 14, 2026
Impact Level	Medium
Specialties Affected	Hematology/Oncology, Bone Marrow Transplant programs, Apheresis units, Infusion billing
Key Action	Audit active plerixafor cases to confirm G-CSF or chemo-mobilization precedence and confirm treatment duration does not exceed four consecutive days

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Aetna Plerixafor Coverage Criteria and Medical Necessity Requirements 2026

Aetna's plerixafor coverage policy under CPB 0779 sets two hard gates for medical necessity. Both must be satisfied before J2562 will get paid.

Gate 1: Prior treatment context. The plerixafor injection must be administered in one of three scenarios. First, after the member has received a granulocyte-colony stimulating factor — a G-CSF such as filgrastim (J1442), tbo-filgrastim (J1447), pegfilgrastim (J2505 or J2506), sargramostim (J2820), or their biosimilar equivalents (Q5110, Q5111). Second, after the member has received chemo-mobilization. Third, as part of a gene therapy protocol.

The "or" between those three scenarios matters. Plerixafor used after chemo-mobilization alone — without G-CSF — still qualifies. Gene therapy protocols also qualify independently. You don't need G-CSF if one of the other two pathways is documented.

Gate 2: Duration limit. Plerixafor use cannot extend beyond four consecutive days, and it must stop at the completion of stem cell harvest or apheresis — whichever comes first. If your team is billing J2562 for a fifth or sixth day, that claim will not survive. There's no ambiguity here.

Continuation of therapy follows the same standard. New members who come to Aetna mid-treatment must meet the same initial medical necessity criteria. There's no grandfather period for prior payer approvals.

Prior authorization requirements aren't explicitly stated in this policy text, but given the drug's significant acquisition cost — confirm current pricing with your pharmacy or GPO — you should treat prior auth as a practical requirement. Confirm PA protocols with Aetna before initiating therapy for any new member. Document the treatment sequence from day one.

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Aetna Plerixafor Exclusions and Non-Covered Indications

Aetna classifies all indications outside the two approved gates above as experimental, investigational, or unproven. The policy states this explicitly.

That's a broad exclusion. Any use of plerixafor that doesn't follow G-CSF administration, chemo-mobilization, or a gene therapy protocol is out. Any treatment extending beyond four consecutive days is out, regardless of clinical rationale or patient response.

If your oncology team is using plerixafor for any off-label indication not documented as following G-CSF administration, chemo-mobilization, or a gene therapy protocol — document carefully and expect a denial. The Aetna plerixafor coverage policy as written does not carve out exceptions for these uses. If your program has a specific clinical scenario that seems to fall in a gray area, loop in your compliance officer before billing.

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Coverage Indications at a Glance

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Aetna Plerixafor Billing Guidelines and Action Items 2026

These are the steps your billing and clinical teams need to take now, not after the first denial hits.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Plerixafor Under CPB 0779

HCPCS Codes — Covered When Selection Criteria Are Met

Code	Description Copy
J2562	Injection, plerixafor, 1 mg [Mozobil]

HCPCS Codes — Related to CPB 0779 (G-CSF and Supporting Agents)

These codes represent the G-CSF agents that must precede plerixafor for coverage. Their presence in the medical record and claims history is part of what establishes medical necessity for J2562.

CPT Codes — Related to CPB 0779 (Harvest, Transplantation, and Administration)

Key ICD-10-CM Diagnosis Codes

Plerixafor billing ties to the underlying malignancy or condition requiring stem cell transplant. The ICD-10-CM codes associated with CPB 0779 span a wide range of hematologic malignancies, solid tumors, and infectious diagnoses. The most clinically relevant for transplant programs are listed here.

The full ICD-10-CM list in CPB 0779 includes 184 codes. The complete list spans infectious diseases (dengue fever A90, A91; West Nile virus A92.30–A92.39; zoster with nervous system involvement B02.21–B02.29; malaria B50.0–B54) alongside the oncologic diagnoses above. For the full code list, check the policy directly at app.payerpolicy.org/p/aetna/0779.

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