Tafasitamab-cxix (Monjuvi) — CPB 0979 | AETNA Coverage Update

Aetna modified CPB 0979 for tafasitamab-cxix (Monjuvi), effective November 6, 2025. Here's what changes for billing teams.

Aetna, a CVS Health company, updated its tafasitamab-cxix Monjuvi coverage policy under CPB 0979 to add follicular lymphoma as a covered indication and expand criteria for other B-cell lymphomas. If your team bills J9349 for Monjuvi infusions, this policy shift directly affects your prior authorization submissions, your ICD-10 code selection, and your cycle-count documentation. The changes are live now — audit your open authorizations before your next submission.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Tafasitamab-cxix (Monjuvi) — CPB 0979
Policy Code	CPB 0979
Change Type	Modified
Effective Date	November 6, 2025
Impact Level	High
Specialties Affected	Hematology/Oncology, Infusion Centers, Hospital Outpatient
Key Action	Update prior auth submissions for follicular lymphoma and B-cell lymphoma indications; verify J9349 charge capture reflects new cycle limits and combination regimen requirements

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Aetna Tafasitamab-cxix (Monjuvi) Coverage Criteria and Medical Necessity Requirements 2025

The core of this Aetna Monjuvi coverage policy is a maximum of 12 cycles, full stop. Whether you're submitting for follicular lymphoma or DLBCL, Aetna will not approve beyond 12 cycles on initial authorization. That cycle cap is the single most important number in this policy.

Follicular Lymphoma — New in CPB 0979

Aetna now considers Monjuvi medically necessary for relapsed or refractory follicular lymphoma when used in a triple combination: tafasitamab-cxix plus lenalidomide plus rituximab. This is new. Prior to this update, follicular lymphoma did not appear as a covered indication under CPB 0979 in Aetna's commercial plans.

The combination requirement is strict. All three agents — Monjuvi, lenalidomide, and rituximab — must be part of the regimen for follicular lymphoma approval. A two-drug combination will not satisfy the criteria. Your prior auth submission must reflect the complete regimen.

ICD-10 codes C82.00 through C82.9A cover follicular lymphoma. Make sure your diagnosis coding maps precisely to the documented histology. Aetna won't connect a vague lymphoma code to this new indication on its own.

Other B-Cell Lymphomas — What Qualifies

For other B-cell lymphomas, Aetna's medical necessity criteria require Monjuvi in combination with lenalidomide — no rituximab requirement here — and the member must meet at least one of five specific diagnoses:

That stem cell transplant eligibility exclusion matters. If a member has histologic transformation to DLBCL and is eligible for autologous stem cell transplant, Aetna will deny Monjuvi for this indication. Document transplant ineligibility clearly in the clinical record before you submit.

For DLBCL, bill ICD-10 codes C83.30 through C83.3A. For HIV-related B-cell lymphoma, use C85.10 through C85.19. For PTLD, use D47.Z1. If the member has stem cell transplant history, Z94.84 is relevant to your documentation package.

Prior Authorization Requirements

Precertification is required for all Aetna participating providers and members in applicable plan designs. Call (866) 752-7021 or fax (888) 267-3277. Statement of Medical Necessity forms are available through Aetna's Specialty Pharmacy Precertification page.

Do not skip this step. Monjuvi is a high-cost biologic. A missing or incomplete prior auth means a claim denial — and when you stack J9349 with administration codes 96413 through 96417, the per-cycle cost exposure is significant. Check your contract and fee schedule for actual reimbursement rates.

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Aetna Tafasitamab-cxix (Monjuvi) Exclusions and Non-Covered Indications

Aetna is explicit here: all indications not listed in CPB 0979 are considered experimental, investigational, or unproven. There is no gray zone. If the diagnosis doesn't match one of the five B-cell lymphoma criteria or follicular lymphoma, Aetna will deny the claim.

This means any Monjuvi billing for T-cell lymphomas, Hodgkin lymphoma, or off-label solid tumor use gets denied under this coverage policy. Don't submit without a matching covered indication.

If you're treating a member with a borderline diagnosis — for example, a B-cell lymphoma histology that doesn't clearly map to one of the five listed subtypes — loop in your compliance officer before submitting. An incorrect indication on the auth request creates downstream problems, including potential overpayment recovery exposure.

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Coverage Indications at a Glance

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Aetna Tafasitamab-cxix (Monjuvi) Billing Guidelines and Action Items 2025

The effective date of November 6, 2025 means this is already live. If you've submitted Monjuvi auths since that date without reviewing CPB 0979 in its current form, audit those submissions now.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Tafasitamab-cxix (Monjuvi) Under CPB 0979

Covered HCPCS Codes (When Selection Criteria Are Met)

CPT Codes for IV Chemotherapy Administration

The descriptions below reflect standard CPT definitions. CPB 0979 lists these codes as related to the policy but does not restate full descriptor text.

Note on lenalidomide: Aetna's policy lists lenalidomide as a required combination agent but does not assign a specific HCPCS code for it within CPB 0979. Bill lenalidomide under your standard specialty pharmacy billing pathway.

Key ICD-10-CM Diagnosis Codes

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