Aetna modified CPB 0887 for belinostat (Beleodaq), effective December 10, 2025. Here's what billing teams need to know before submitting claims.
Aetna, a CVS Health company, updated its belinostat coverage policy under CPB 0887 Aetna system, expanding the approved indications for this IV histone deacetylase (HDAC) inhibitor used in T-cell lymphoma treatment. The policy now covers five distinct T-cell lymphoma subtypes — each with its own medical necessity criteria. If your team bills J9032 (injection, belinostat, 10 mg) along with chemotherapy administration codes 96413 through 96417, this update directly affects your prior authorization submissions and claim documentation requirements.
Quick-Reference Table
| Field | Detail |
|---|---|
| Payer | Aetna (CPB 0887) |
| Policy | Belinostat (Beleodaq) — CPB 0887 |
| Policy Code | CPB 0887 |
| Change Type | Modified |
| Effective Date | December 10, 2025 |
| Impact Level | High |
| Specialties Affected | Hematology/Oncology, Infusion Centers, Hospital Outpatient, Revenue Cycle |
| Key Action | Update prior authorization templates and clinical documentation to match the five T-cell lymphoma subtype criteria before submitting new claims under J9032 |
Aetna Belinostat Coverage Criteria and Medical Necessity Requirements 2025
The Aetna belinostat coverage policy under CPB 0887 is more granular than most oncology policies. Aetna approves belinostat for five T-cell lymphoma categories, and each one has its own set of conditions. A claim that's perfect for one subtype gets denied on another if you're missing one criterion. Know the differences before you submit.
Peripheral T-Cell Lymphoma (PTCL)
This is the broadest category. It covers anaplastic large cell lymphoma, PTCL not otherwise specified (NOS), angioimmunoblastic T-cell lymphoma, enteropathy-associated T-cell lymphoma (EATL), monomorphic epitheliotropic intestinal T-cell lymphoma (MEITL), nodal peripheral T-cell lymphoma with TFH phenotype, and follicular T-cell lymphoma.
Two conditions must be met for medical necessity. First, belinostat must be used as a single agent. Second, it must be used for relapsed or refractory disease, or for palliative intent. That palliative intent language is notable — it gives you a second pathway beyond relapsed/refractory when the clinical picture calls for it.
Hepatosplenic T-Cell Lymphoma
This subtype has a prior treatment threshold. Belinostat is covered as a single agent only after the member has completed two or more previous lines of chemotherapy. Document the prior treatment lines explicitly in your clinical notes. Aetna reviewers look for this, and a vague reference to "prior therapy" won't hold up on appeal.
Extranodal NK/T-Cell Lymphoma
This is the most restrictive category. Three conditions must all be present: single-agent use, relapsed or refractory disease, and an inadequate response to asparaginase-based therapy — or a documented contraindication to it. Pegaspargase is the named example in the policy. If your patient couldn't tolerate pegaspargase, document why. If they failed it, document that too. Missing the asparaginase criterion is a common denial trigger for this subtype.
Adult T-Cell Leukemia/Lymphoma (ATLL)
Coverage requires single-agent use for subsequent therapy. No specific prior line count is stated, unlike hepatosplenic T-cell lymphoma. "Subsequent therapy" means the member has had at least one prior treatment — confirm that's in the record before you request prior authorization.
Breast Implant-Associated Anaplastic Large Cell Lymphoma (BIA-ALCL)
Same structure as ATLL: single-agent use, subsequent therapy. This is a rare indication but it's explicitly covered. If you're seeing BIA-ALCL patients, belinostat billing is a viable path under this policy.
Continuation of Therapy
Aetna covers continued belinostat therapy when two conditions are met. There is no unacceptable toxicity on the current regimen. There is no disease progression. Your continuation request needs clinical documentation showing both — not just one. An oncology note that says "patient tolerating well" without addressing response is not enough.
Aetna Belinostat Exclusions and Non-Covered Indications
Aetna's position is direct: every indication not listed above is considered experimental, investigational, or unproven. There is no gray area here.
If a clinician wants to use belinostat for a solid tumor, a B-cell malignancy, or any off-label T-cell indication not named in CPB 0887, Aetna won't cover it under this policy. The ICD-10 code list attached to this policy includes codes for stomach, colon, liver, pancreatic, and lung malignancies — but those diagnoses don't create a coverage pathway. They appear in the code table for reference, not as covered indications.
Don't submit belinostat claims with a solid tumor primary diagnosis expecting coverage. That's a denial waiting to happen. If your physician has clinical rationale for an off-label use, that's a case for your compliance officer and a formal medical exception request — not a standard claim.
Coverage Indications at a Glance
| Indication | Status | Key Codes | Notes |
|---|---|---|---|
| Peripheral T-cell lymphoma (PTCL NOS, ALCL, AITL, EATL, MEITL, nodal TFH, follicular T-cell) | Covered | J9032, 96413–96417 | Single agent only; relapsed/refractory or palliative intent required |
| Hepatosplenic T-cell lymphoma | Covered | J9032, 96413–96417 | Single agent; ≥2 prior lines of chemotherapy required |
| Extranodal NK/T-cell lymphoma | Covered | J9032, 96413–96417 | Single agent; relapsed/refractory; failed or contraindicated to asparaginase (e.g., pegaspargase) |
| Adult T-cell leukemia/lymphoma (ATLL) | Covered | J9032, 96413–96417 | Single agent; subsequent therapy only |
| Breast implant-associated ALCL (BIA-ALCL) | Covered | J9032, 96413–96417 | Single agent; subsequent therapy only |
| All other indications (solid tumors, B-cell malignancies, unlisted T-cell variants) | Not Covered | — | Considered experimental, investigational, or unproven by Aetna |
| Continuation of therapy (any covered indication) | Covered | J9032, 96413–96417 | Requires no unacceptable toxicity and no disease progression |
Aetna Belinostat Billing Guidelines and Action Items 2025
The effective date is December 10, 2025. Claims submitted on or after that date fall under the updated CPB 0887 criteria. Here's what to do now.
| # | Action Item |
|---|---|
| 1 | Update your prior authorization templates by December 10, 2025. Each of the five covered subtypes has different documentation requirements. Build subtype-specific PA checklists so your team isn't submitting generic PTCL requests when the patient has extranodal NK/T-cell lymphoma. |
| 2 | Verify single-agent language in every belinostat order. All five covered indications require single-agent use. If belinostat is ordered as part of a combination regimen, Aetna won't cover it under CPB 0887. Catch this at the PA stage, not after a claim denial. |
| 3 | Document prior treatment lines explicitly for hepatosplenic T-cell lymphoma. Aetna requires at least two prior chemotherapy lines for this subtype. The clinical notes need to name those regimens — dates, drugs, and outcome. "Prior treatment" with no details won't survive a denial appeal. |
| 4 | Flag extranodal NK/T-cell claims for asparaginase documentation review. This subtype requires proof of pegaspargase failure or contraindication. Build a documentation checklist for this indication specifically. It's the criterion most likely to be missing when a claim gets denied. |
| 5 | Bill J9032 per 10 mg of belinostat administered, paired with the appropriate chemotherapy administration code. The standard infusion administration codes are 96413 (first hour), 96415 (each additional hour), 96414 (concurrent), 96416 (initiation of prolonged infusion), and 96417 (each additional sequential infusion drug). Match the code to the actual administration scenario — don't default to 96413 for every encounter. |
| 6 | Audit continuation of therapy requests before submission. Aetna requires documentation of both tolerability and disease response for continuation coverage. Your oncology notes need to address both. A note that only documents tolerability — without addressing response — creates a denial risk. |
| 7 | Talk to your compliance officer if you're billing belinostat for any indication not on this list. The policy is explicit that everything else is experimental or unproven. Off-label use with commercial Aetna plans needs a medical exception pathway, not a standard claim submission. |
| 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 Code (When Selection Criteria Are Met)
| Code | Type | Description |
|---|---|---|
| J9032 | HCPCS | Injection, belinostat, 10 mg |
Chemotherapy Administration CPT Codes
These codes apply to the IV infusion of belinostat. Select the code that matches the actual administration scenario.
| Code | Type | Description |
|---|---|---|
| 96413 | CPT | Chemotherapy administration, intravenous infusion technique; up to one hour, single or initial substance/drug |
| 96414 | CPT | Chemotherapy administration, intravenous infusion technique; concurrent infusion |
| 96415 | CPT | Chemotherapy administration, intravenous infusion technique; each additional hour |
| 96416 | CPT | Chemotherapy administration, intravenous infusion technique; initiation of prolonged chemotherapy infusion (more than 8 hours), requiring use of a portable or implantable pump |
| 96417 | CPT | Chemotherapy administration, intravenous infusion technique; each additional sequential infusion (different substance/drug), up to one hour |
Key ICD-10-CM Diagnosis Codes
The policy references 372 ICD-10-CM codes. The T-cell lymphoma codes most relevant to covered indications are the C84 and C86 series. The codes below represent the primary diagnoses your team will use most often. Confirm the full code list for your specific patient population in the CPB 0887 source policy.
Note: The solid tumor codes listed in the policy data (stomach C16.x, colon C18.0, rectum C20, liver C22.0, pancreas C25.x, lung C34.x) are referenced in the policy but do not create a covered pathway for belinostat. Submitting belinostat claims with these primary diagnoses will result in denial.
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