Brexucabtagene Autoleucel (Tecartus) - 0980 — CPB 0980 | AETNA Coverage Update

Aetna modified CPB 0980 for brexucabtagene autoleucel (Tecartus), effective February 14, 2026. Here's what billing teams need to know.

Aetna, a CVS Health company, updated its Tecartus coverage policy under CPB 0980 in Aetna systems, with the change taking effect on February 14, 2026. The policy governs HCPCS code Q2053 — the primary billing code for brexucabtagene autoleucel — along with the CAR-T therapy procedure codes (CPT 38225–38228 and the legacy T-codes 0537T–0540T). This update refines medical necessity criteria for two indications: relapsed or refractory mantle cell lymphoma and adult B-cell precursor acute lymphoblastic leukemia (ALL).

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna
Policy	Brexucabtagene Autoleucel (Tecartus)
Policy Code	CPB 0980
Change Type	Modified
Effective Date	2026-02-14
Impact Level	High
Specialties Affected	Oncology, Hematology, Infusion/Cellular Therapy
Key Action	Verify ALL and MCL patients meet all eligibility criteria and obtain precertification through NME before submitting claims with Q2053

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Aetna Brexucabtagene Autoleucel Coverage Criteria and Medical Necessity Requirements 2026

Aetna's Tecartus coverage policy routes all requests through the Aetna GCIT® (Gene-based, Cellular & Other Innovative Therapies) team. This is a dedicated review unit — not standard utilization management. That matters because GCIT reviews move differently than routine prior authorization requests, and your team needs to treat them accordingly.

Precertification is mandatory. Contact National Medical Excellence (NME) directly at 1-877-212-8811 before any Tecartus infusion. This applies to all Aetna participating providers and members in applicable plan designs. Missing this step guarantees a claim denial on Q2053 — there is no workaround.

Aetna considers Tecartus medically necessary for two indications only. Everything else is experimental, investigational, or unproven. The two covered indications are relapsed/refractory mantle cell lymphoma (ICD-10 C83.10–C83.19) and adult B-cell precursor ALL (ICD-10 C91.0–C91.2). Each has its own eligibility ladder, and a patient must clear every rung.

Mantle Cell Lymphoma (MCL) Criteria

For MCL, the criteria are relatively straightforward. The member must be 18 or older. The disease must be relapsed or refractory. The member must not have previously received brexucabtagene autoleucel or any other CD19-directed CAR-T therapy. That's it — but "relapsed or refractory" must be documented clearly in the record to support prior authorization.

One dose only. This is a one-time treatment under the policy.

Adult B-cell Precursor ALL Criteria

The ALL pathway is more detailed, and this is where most documentation gaps will cause problems.

The member must be 18 or older and must not have received prior brexucabtagene autoleucel or another CD19-directed CAR-T therapy. Prior CD19-directed therapy with blinatumomab is the one exception — members who received blinatumomab can still be eligible.

From there, the member must meet disease-status criteria under one of two branches:

Philadelphia chromosome-negative (Ph-) disease — the member must meet at least one of:

Philadelphia chromosome-positive (Ph+) disease — the member must meet at least one of:

#	Covered Indication Copy
1	Relapsed or refractory despite treatment with at least two different TKIs (e.g., bosutinib, dasatinib, imatinib, nilotinib, ponatinib)
2	Intolerance to TKI therapy

Two additional criteria apply to ALL members regardless of Ph status. First, morphological disease in the bone marrow — defined as ≥5% blasts — must be present. Second, the member must not have active graft versus host disease (GvHD). Both must be documented in the clinical record before precertification.

Universal Exclusions

Four exclusions apply across both indications. Any one of them disqualifies the member:

Document ECOG status explicitly. Aetna reviewers will look for it.

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Aetna Tecartus Exclusions and Non-Covered Indications

Aetna considers all Tecartus use outside the two approved indications to be experimental, investigational, or unproven. There are no additional covered indications in CPB 0980.

Pediatric use is not covered under this commercial policy. The policy explicitly limits both indications to members 18 years of age or older.

Any member who received prior brexucabtagene autoleucel or another CD19-directed CAR-T therapy is excluded from both indications. This is a hard stop — prior CAR-T exposure closes the door entirely, with the narrow blinatumomab exception in the ALL pathway.

For ALL patients, active GvHD is an absolute exclusion. If your clinical team is considering Tecartus for a post-transplant patient who currently has GvHD, the claim will be denied. Document that GvHD is absent or resolved before the precertification request goes in.

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Coverage Indications at a Glance

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Aetna Tecartus Billing Guidelines and Action Items 2026

The reimbursement exposure on Tecartus is significant — this is one of the highest-cost therapies in oncology billing. A single claim denial on Q2053 is not a minor miss. Work through these steps before the infusion date, not after.

Copy Action Items

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CPT, HCPCS, and ICD-10 Codes for Brexucabtagene Autoleucel Under CPB 0980

HCPCS Code — Primary Billing Code

Code	Type	Description Copy
Q2053	HCPCS	Brexucabtagene autoleucel, up to 200 million autologous anti-cd19 car positive viable t cells, inclu (description truncated in source data — verify the full description against the official CPB 0980 policy text before billing)

CAR-T Procedure CPT Codes

Infusion Administration CPT Codes

Key ICD-10-CM Diagnosis Codes

Note: The full ICD-10 code set in CPB 0980 includes 267 codes spanning hepatitis, cardiac, pulmonary, and other exclusion-related diagnoses. The codes above represent the primary covered indications. Review the full policy at CPB 0980 Aetna for the complete list.

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