Motixafortide (Aphexda) — CPB 1046 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 1046 covering motixafortide (Aphexda) for hematopoietic stem cell mobilization, with an effective date of February 14, 2026. Here's what changes for billing teams.

CPB 1046 governs Aetna reimbursement for J2277 (injection, motixafortide, 0.25 mg) in multiple myeloma patients undergoing autologous stem cell collection. The modification tightens the three-part criteria sequence that must be met before Aetna approves a claim — and if your billing team isn't documenting each step explicitly, you're looking at a claim denial before the drug even ships to the patient.

Quick-Reference Table

Aetna Motixafortide Coverage Criteria and Medical Necessity Requirements 2026

The Aetna motixafortide coverage policy under CPB 1046 is narrow by design. Coverage applies only to multiple myeloma — ICD-10 codes C90.0, C90.1, and C90.2 — and only when the drug is used for one specific purpose: mobilizing hematopoietic stem cells before apheresis.

Three criteria must ALL be met for Aetna to consider motixafortide medically necessary. Miss one, and the claim fails — it's that binary.

Criterion 1: The drug must be used to mobilize hematopoietic stem cells for collection. This sounds obvious, but it matters for documentation. Your clinical notes need to state the mobilization intent clearly. Don't assume the diagnosis alone justifies coverage.

Criterion 2: Motixafortide must be administered after the member has received four daily doses of G-CSF. Aetna names filgrastim as the example, but the policy's code list includes the full G-CSF family — J1442 (filgrastim, excludes biosimilars), J1447 (tbo-filgrastim), C9173 (filgrastim-txid, biosimilar Nypozi), Q5101 (filgrastim-sndz, biosimilar Zarxio), Q5110 (filgrastim-aafi, biosimilar Nivestym), and Q5125 (filgrastim-ayow, biosimilar Releuko). The sequencing is a hard requirement. Four doses of G-CSF must precede motixafortide — document the start date and each daily dose.

Criterion 3: Motixafortide will not be used beyond two doses or after completion of stem cell harvest/apheresis. This is a dose-limit rule. Billing beyond two administrations of J2277, or after apheresis is complete, puts every claim past that line at risk.

The continuation of therapy rule is straightforward: new members who meet the initial criteria get the same coverage. There's no gap or additional hurdle for members who switch to an Aetna commercial plan mid-course. Confirm the original criteria still apply and document accordingly.

Aetna Motixafortide Exclusions and Non-Covered Indications

Aetna is direct here. Every indication other than hematopoietic stem cell mobilization in multiple myeloma is experimental, investigational, or unproven.

That's a broad exclusion. Motixafortide has been studied in other stem cell mobilization contexts — non-Hodgkin lymphoma, for example — and researchers are actively exploring new uses. Under this coverage policy, none of that matters for Aetna commercial claims. If the diagnosis isn't C90.0, C90.1, or C90.2, the claim will not be covered.

If you're billing for a patient who has myeloma and another hematologic condition being treated simultaneously, the indication on the motixafortide claim must tie to the myeloma stem cell harvest. Any ambiguity in the diagnosis linking will trigger a claim denial. Be precise with your ICD-10 sequencing on those claims.

Coverage Indications at a Glance

Aetna Motixafortide Billing Guidelines and Action Items 2026

The policy is live as of February 14, 2026. If you're treating Aetna commercial members with motixafortide right now, these steps apply immediately.

CPT, HCPCS, and ICD-10 Codes for Motixafortide Under CPB 1046

Covered HCPCS Codes (When Selection Criteria Are Met)

Related G-CSF HCPCS Codes (Supporting Therapy — Sequencing Required)

Motixafortide approval depends on prior G-CSF administration. These codes represent the G-CSF agents Aetna references in the policy.

ICD-10-CM Diagnosis Codes