Glofitamab-gxbm (Columvi) — CPB 1036 | AETNA Coverage Update

Aetna modified CPB 1036 for glofitamab-gxbm (Columvi), effective 2026-02-25. Here's what billing teams need to do.

Aetna, a CVS Health company, updated its glofitamab-gxbm (Columvi) coverage policy under CPB 1036 Aetna system, effective February 25, 2026. This change defines specific medical necessity criteria for two distinct treatment scenarios — combination therapy with GemOx and single-agent use after prior lines of therapy. The primary billing codes affected are J9286 (glofitamab-gxbm injection, 2.5 mg) and CPT codes 96413, 96414, and 96415 for intravenous chemotherapy administration. If your oncology or hematology billing team handles Columvi claims, this policy sets the rules for what Aetna will and won't pay.

---

Quick-Reference Table

Field	Detail Copy
Payer	Aetna, a CVS Health company
Policy	Glofitamab-gxbm (Columvi) — CPB 1036
Policy Code	CPB 1036
Change Type	Modified
Effective Date	2026-02-25
Impact Level	High
Specialties Affected	Hematology, Oncology, Infusion Centers, Hospital Outpatient
Key Action	Confirm obinutuzumab pretreatment and prior treatment line documentation before submitting J9286 claims

---

Aetna Glofitamab-gxbm Coverage Criteria and Medical Necessity Requirements 2026

Aetna's glofitamab-gxbm (Columvi) coverage policy under CPB 1036 gates every claim on two gatekeeping requirements before anything else. First, the member must receive a single dose of obinutuzumab (Gazyva), billed as J9301, 7 days before Columvi initiation, per the policy requirement. Miss that pretreatment step in your documentation — or skip it clinically — and Aetna will deny the claim. That's a hard stop, not a suggestion.

Once the obinutuzumab pretreatment is confirmed, coverage splits into two separate tracks. The track your claim falls into determines which diagnosis codes apply, what prior treatment history you need to document, and whether combination agents like gemcitabine and oxaliplatin are part of the covered regimen.

Track 1: Combination therapy with GemOx

Aetna covers glofitamab-gxbm in combination with GemOx (gemcitabine and oxaliplatin) as subsequent therapy for relapsed or refractory disease. The eligible subtypes under this track are:

Gemcitabine in this regimen can be billed under J9184, J9196, J9198, or J9201 depending on the formulation. Oxaliplatin is J9263. Bill all combination agents on the same claim with J9286, and make sure your diagnosis codes align with the eligible subtypes listed above.

Track 2: Single-agent use after 2+ prior lines

The single-agent track requires at least two prior lines of systemic therapy. The member also must have partial response, no response, progressive disease, relapsed disease, or refractory disease at the time of Columvi initiation. Eligible subtypes under this track are:

The real issue here is documentation depth. Aetna's prior authorization review for single-agent claims will look for evidence of two documented prior systemic therapy lines and the current disease status. If your oncology notes don't explicitly state the number of prior regimens and the response assessment, expect a denial or a lengthy prior auth fight.

Precertification is required for all Aetna participating providers and members in applicable plan designs. Call (866) 752-7021 or fax (888) 267-3277 to initiate. This is a prior authorization process — not a courtesy notification — and reimbursement depends on it.

---

Aetna Glofitamab-gxbm Exclusions and Non-Covered Indications

Aetna considers all uses of glofitamab-gxbm outside the criteria in Section I to be experimental, investigational, or unproven. That language matters for claim denial risk. If a provider uses Columvi for a B-cell lymphoma subtype not listed above — or without the obinutuzumab pretreatment — Aetna won't cover it under this policy.

There is no coverage pathway in this policy for indications like follicular lymphoma, mantle cell lymphoma, marginal zone lymphoma, or T-cell lymphomas. If your providers are exploring Columvi for those diagnoses, those claims will deny. Route those situations through your medical director for a formal appeals or medical exception process before the drug is administered.

---

Coverage Indications at a Glance

One nuance worth flagging: HIV-related plasmablastic lymphoma appears in the GemOx combination track but is absent from the single-agent track. If your team is billing single-agent Columvi for a plasmablastic lymphoma patient, that claim will deny under this policy. Confirm the track before submitting.

---

Aetna Glofitamab-gxbm Billing Guidelines and Action Items 2026

This is where Columvi billing gets operationally complex. The obinutuzumab pretreatment requirement, the two-track structure, and the prior auth requirement create multiple failure points. Work through these steps before your first claim goes out after the February 25, 2026 effective date.

Copy Action Items

---

CPT, HCPCS, and ICD-10 Codes for Glofitamab-gxbm (Columvi) Under CPB 1036

Covered HCPCS Code (When Selection Criteria Are Met)

Code	Type	Description Copy
J9286	HCPCS	Injection, glofitamab-gxbm, 2.5 mg

Supporting HCPCS Codes Related to CPB 1036

These codes support the GemOx combination regimen and obinutuzumab pretreatment. They are not independently governed by this CPB but appear in the policy context.

CPT Codes for Chemotherapy Administration

Code	Type	Description Copy
96413	CPT	Chemotherapy administration, intravenous infusion technique
96414	CPT	Chemotherapy administration, intravenous infusion technique
96415	CPT	Chemotherapy administration, intravenous infusion technique

ICD-10-CM Diagnosis Codes

Note: C85.20–C85.29 appears in the policy's ICD-10 code list but is not named as a covered indication in the policy criteria text. Confirm applicability with your coding team before use.

---