Aetna modified CPB 0887 for belinostat (Beleodaq), effective December 10, 2025. Here's what billing teams need to do before claims hit the queue.
Aetna updated its belinostat coverage policy under CPB 0887 with revised medical necessity criteria covering five T-cell lymphoma subtypes. The policy governs HCPCS J9032 (injection, belinostat, 10 mg) and ties directly to chemotherapy administration codes CPT 96413–96417. If your oncology or infusion center bills for this drug, the December 10, 2025 effective date is already live — meaning claims going out now need to match these updated criteria or you're looking at a denial.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna, a CVS Health company |
| Policy | Belinostat (Beleodaq) — CPB 0887 |
| Policy Code | CPB 0887 |
| Change Type | Modified |
| Effective Date | December 10, 2025 |
| Impact Level | High — subtype-level medical necessity criteria and line-of-therapy requirements all in play |
| Specialties Affected | Hematology/Oncology, Infusion Centers, Hospital Outpatient |
| Key Action | Audit all pending belinostat (J9032) authorizations against the updated subtype-specific criteria before submitting claims |
Aetna Belinostat Coverage Criteria and Medical Necessity Requirements 2025
Aetna's belinostat coverage policy under CPB 0887 is structured around one core principle: this drug is covered only as a single agent, only for T-cell lymphomas, and only in specific lines of therapy. There is no combination-therapy pathway here. If your oncologist is using belinostat alongside another agent, you're not getting it covered under this policy.
The policy breaks down into five distinct T-cell lymphoma subtypes, each with its own medical necessity criteria. You can't treat them as interchangeable. A claim that passes for peripheral T-cell lymphoma not otherwise specified won't pass for hepatosplenic T-cell lymphoma if the line-of-therapy requirement isn't documented.
Peripheral T-cell lymphoma (PTCL) is the broadest category. It covers anaplastic large cell lymphoma, PTCL not otherwise specified, angioimmunoblastic T-cell lymphoma, enteropathy-associated T-cell lymphoma, monomorphic epitheliotropic intestinal T-cell lymphoma, nodal PTCL with TFH phenotype, and follicular T-cell lymphoma. For all of these, Aetna requires two things: single-agent use and either relapsed/refractory disease or palliative intent. No prior-line minimum — just the relapsed/refractory or palliative documentation.
Hepatosplenic T-cell lymphoma has a harder line-of-therapy requirement. The member must have had two or more previous lines of chemotherapy. Document that clearly in your medical necessity submission. If you can't show two prior lines, the medical necessity argument falls apart before it starts.
Extranodal NK/T-cell lymphoma has the strictest criteria of the five. The member must have relapsed or refractory disease, must be using belinostat as a single agent, and must have had either an inadequate response or a contraindication to asparaginase-based therapy — specifically, something like pegaspargase. That contraindication or failed response needs to be in the medical record. This is where documentation gets scrutinized hardest.
Adult T-cell leukemia/lymphoma (ATLL) requires single-agent use and subsequent therapy — meaning this can't be first-line. If your physician is proposing belinostat as initial treatment for ATLL, this policy won't cover it.
Breast implant-associated anaplastic large cell lymphoma (BIA-ALCL) follows the same structure as ATLL: single agent, subsequent therapy only. First-line use is not covered.
For continuation of therapy, Aetna applies a clean standard: no evidence of unacceptable toxicity, no disease progression. If either of those conditions appears, coverage stops. Build ongoing clinical documentation of response and tolerability into your workflow now, so it's available when continuation is reviewed.
Belinostat billing under this policy requires matching every claim back to these subtype-specific criteria. Generic T-cell lymphoma documentation won't hold up. You need the subtype, the line of therapy, and the single-agent confirmation in every medical necessity submission.
Aetna Belinostat Exclusions and Non-Covered Indications
Aetna is direct about this: all indications outside the five listed above are considered experimental, investigational, or unproven. There is no off-label pathway documented in this policy.
This matters practically. Belinostat has been studied in other contexts — cutaneous T-cell lymphoma, solid tumors, and combination regimens. None of those indications are covered under this policy. If your physician has a patient who doesn't fit one of the five subtypes, you're looking at a denial on first submission.
The real issue here is the combination-therapy restriction. The policy is explicit that all five covered indications require single-agent use. Any claim that reflects belinostat as part of a multi-drug regimen fails the medical necessity standard, regardless of the diagnosis.
Coverage Indications at a Glance
| Indication | Status | Key HCPCS Code | Critical Criteria |
|---|---|---|---|
| Peripheral T-cell lymphoma (PTCL and listed subtypes) | Covered | J9032 | Single agent; relapsed/refractory or palliative intent |
| Hepatosplenic T-cell lymphoma | Covered | J9032 | Single agent; ≥2 prior chemotherapy lines required |
| Extranodal NK/T-cell lymphoma | Covered | J9032 | Single agent; relapsed/refractory; prior inadequate response or contraindication to asparaginase-based therapy |
| Adult T-cell leukemia/lymphoma (ATLL) | Covered | J9032 | Single agent; subsequent therapy only (not first-line) |
| Breast implant-associated ALCL (BIA-ALCL) | Covered | J9032 | Single agent; subsequent therapy only (not first-line) |
| All other indications (solid tumors, other lymphomas, combination regimens) | Not Covered — Experimental/Investigational | — | No pathway available under this policy |
| Continuation of therapy | Covered (conditional) | J9032 | No unacceptable toxicity; no disease progression |
Aetna Belinostat Billing Guidelines and Action Items 2025
The December 10, 2025 effective date is already behind us. If your team hasn't reviewed your belinostat claims workflow against this updated policy, do it now.
| # | Action Item |
|---|---|
| 1 | Audit all open belinostat (J9032) claims against the five covered subtypes. Confirm the documented subtype and line-of-therapy align with the current requirements. Mismatched documentation is a claim denial waiting to happen. |
| 2 | Verify the single-agent requirement is documented in every claim. This is the one criterion that applies to all five indications without exception. If your charge capture reflects combination use, fix it before submission. |
| 3 | For hepatosplenic T-cell lymphoma cases, pull prior chemotherapy line documentation before submitting. Aetna requires two or more previous lines. That documentation needs to be explicit — not implied — in the medical record. |
| 4 | For extranodal NK/T-cell lymphoma, confirm asparaginase therapy history is in the record. You need documentation of either an inadequate response to pegaspargase or a clinical contraindication. A simple note saying "asparaginase was not tolerated" won't be enough — get the specifics. |
| 5 | Document response and tolerability for every continuation of therapy claim. The policy requires no evidence of unacceptable toxicity and no disease progression. Work with your clinical team so that continuation submissions include a clear statement of ongoing response and tolerability. This is a medical necessity documentation requirement, not a prior authorization standard — but the documentation still needs to be there. |
| 6 | Map your ICD-10 codes carefully before billing — see the ICD-10 note below. The full code set under this policy contains 372 codes, and the available source data does not display the T-cell lymphoma codes directly. Access the full policy to verify your specific diagnosis codes are included before submitting claims. |
| 7 | If you're billing CPT 96413 through 96417 for infusion administration, confirm those codes are linked to the correct encounter and drug administration documentation. The administration codes don't trigger denial by themselves, but an audit connecting the infusion record to the drug claim will expose any documentation gaps quickly. |
If you have patients who don't fit any of the five covered subtypes but have a strong clinical case, talk to your compliance officer before submitting. There's no off-label pathway in this policy.
| 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 Belinostat Under CPB 0887
Covered HCPCS Codes (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| J9032 | HCPCS | Injection, belinostat, 10 mg |
Chemotherapy Administration CPT Codes (Related to Infusion Billing)
The source policy lists CPT 96413–96417 as codes related to this policy. The source data provides one description for all five: "Chemotherapy administration, intravenous infusion technique." The policy does not include granular time or sequence sub-descriptions for these codes.
| Code | Type | Description |
|---|---|---|
| 96413 | CPT | Chemotherapy administration, intravenous infusion technique |
| 96414 | CPT | Chemotherapy administration, intravenous infusion technique |
| 96415 | CPT | Chemotherapy administration, intravenous infusion technique |
| 96416 | CPT | Chemotherapy administration, intravenous infusion technique |
| 96417 | CPT | Chemotherapy administration, intravenous infusion technique |
ICD-10-CM Diagnosis Codes
The full code set under CPB 0887 contains 372 ICD-10-CM codes. The source data excerpt provided for this policy displays codes for stomach (C16.x), colon (C18.0, C20), liver (C22.0), pancreas (C25.x), and lung malignancies (C34.x). The remaining 292 codes are not displayed in the available data.
The T-cell lymphoma ICD-10 codes relevant to the five covered indications are not visible in the source excerpt. Do not assume your specific T-cell lymphoma diagnosis codes appear in the covered set based on the policy's coverage criteria alone. Access the full code list directly at the CPB 0887 policy page on Aetna's site and verify that your specific diagnosis codes are included before billing.
The presence of solid tumor codes (stomach, colon, liver, pancreas, lung) in the displayed data likely reflects a shared code framework across multiple Aetna oncology policies. Confirm your specific codes against the full list — don't rely on this excerpt.
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