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 before submitting claims.

Aetna, a CVS Health company, updated its coverage policy for Tecartus under CPB 0980 in the Aetna system. This policy covers two indications: relapsed or refractory mantle cell lymphoma (ICD-10 C83.10–C83.19) and adult B-cell precursor acute lymphoblastic leukemia (ICD-10 C91.0–C91.2). The primary billing code is HCPCS Q2053, paired with CAR-T procedure codes CPT 38225–38228.

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Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Brexucabtagene Autoleucel (Tecartus) — CPB 0980
Policy Code	CPB 0980
Change Type	Modified
Effective Date	February 14, 2026
Impact Level	High
Specialties Affected	Hematology/Oncology, Bone Marrow Transplant Programs, Infusion Centers, Hospital Outpatient
Key Action	Verify all four eligibility criteria and confirm no exclusions before submitting prior authorization through NME at 1-877-212-8811

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Aetna Brexucabtagene Autoleucel Coverage Criteria and Medical Necessity Requirements 2026

The Aetna Tecartus coverage policy routes all cases through the GCIT (Gene-based, Cellular & Other Innovative Therapies) team. That's a dedicated review track — not standard utilization management. Expect longer timelines and more documentation scrutiny than a typical oncology prior auth.

Prior authorization is required for every case. Contact National Medical Excellence (NME) at 1-877-212-8811. Do not bill Q2053 without an approved authorization. A claim denial for missing prior auth on a therapy that costs hundreds of thousands of dollars is not a recoverable situation.

Mantle Cell Lymphoma (C83.10–C83.19)

Aetna considers Tecartus medically necessary for relapsed or refractory mantle cell lymphoma when both of the following are met:

#	Covered Indication Copy
1	The member is 18 or older
2	The member has not previously received brexucabtagene autoleucel or any other CD19-directed CAR-T therapy

That's a short criteria list, but the CD19-naive requirement is the one that will trip up claims. If a patient received another CAR-T product first, Tecartus is not covered here. Document prior therapy history explicitly in your auth submission.

Adult B-cell Precursor ALL (C91.0–C91.2)

The ALL criteria are more involved. Medical necessity requires all four of the following:

The Philadelphia chromosome distinction matters. Ph-negative patients need to meet one of four relapse definitions: primary refractory disease, first relapse with remission of 12 months or less, relapsed/refractory after at least two prior systemic therapy lines, or relapsed/refractory after allogeneic stem cell transplant.

Ph-positive patients face a different standard. They need relapsed or refractory disease after at least two different tyrosine kinase inhibitors — or documented TKI intolerance. The examples Aetna lists for TKIs are bosutinib, dasatinib, imatinib, nilotinib, and ponatinib. Name the specific TKIs tried and the outcomes in your auth request.

The bone marrow blast threshold is a hard stop. If your documentation doesn't confirm ≥5% blasts, the authorization will be denied. Make sure pathology results are current and included in your submission.

Aetna's reimbursement on this therapy runs through the GCIT review process for both commercial and Medicare lines. For Medicare-specific criteria, Aetna directs you to their Part B step protocol — that's a separate track from this CPB 0980 commercial coverage policy.

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Aetna Tecartus Exclusions and Non-Covered Indications

Four exclusions disqualify a member from Tecartus coverage entirely. Any one of them is a hard denial. These apply to both indications.

The real issue here is documentation precision. "Inadequate cardiac function" is subjective until you put a specific finding in the record. Aetna's GCIT reviewers will ask for labs, imaging, and specialist notes. Have them ready before you submit — not after the first denial.

All indications outside of relapsed/refractory mantle cell lymphoma and B-cell precursor ALL are considered experimental, investigational, or unproven by Aetna. There is no off-label pathway in this coverage policy.

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Coverage Indications at a Glance

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Aetna Tecartus Billing Guidelines and Action Items 2026

Tecartus billing spans multiple claim events — leukapheresis, manufacturing transport, cell prep, and infusion. Each step has its own code. If your billing team treats this as a single-event claim, expect denials.

Copy Action Items

If your program treats a high volume of CAR-T patients across multiple payers, talk to your compliance officer before February 14, 2026. The GCIT track has different documentation standards than standard oncology auth, and the financial exposure on a denied CAR-T case is significant.

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

HCPCS Codes — Covered When Selection Criteria Are Met

Code	Type	Description Copy
Q2053	HCPCS	Brexucabtagene autoleucel, up to 200 million autologous anti-CD19 CAR-positive viable T cells, including leukapheresis and dose preparation procedures

CPT Codes Related to CPB 0980

Key ICD-10-CM Diagnosis Codes

Note: Aetna's CPB 0980 code set includes 267 ICD-10-CM codes in total. The table above reflects the primary covered diagnosis codes and the most clinically relevant exclusionary codes. Your billing team should review the full code list at the source policy before finalizing charge capture.

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