Tarlatamab-dlle (Imdelltra) — CPB 1062 | AETNA Coverage Update

TL;DR: Aetna, a CVS Health company, modified CPB 1062 covering tarlatamab-dlle (Imdelltra), effective September 26, 2025. Precertification is required for all Aetna participating providers and members in applicable plan designs. Here's what billing teams need to do before claims go out.

This Aetna tarlatamab-dlle coverage policy update touches administration codes in the CPT 96401–96480 range — the chemotherapy infusion and injection series. If your oncology or infusion center bills Aetna for small cell lung cancer treatments, this change is on your radar now.

Quick-Reference Table

Aetna Tarlatamab-dlle Coverage Criteria and Medical Necessity Requirements 2025

The Aetna tarlatamab-dlle coverage policy under CPB 1062 Aetna system requires precertification for every single administration. There are no exceptions for participating providers. If your team skips this step, you're billing into a denial.

Tarlatamab-dlle (Imdelltra) is a bispecific T-cell engager approved for extensive-stage small cell lung cancer. Aetna treats it as a highly complex biologic agent under the chemotherapy administration CPT codes — specifically the 96401 series and its add-on codes through CPT 96480. Every administration requires medical necessity documentation and a completed precertification.

The prior authorization phone line is (866) 752-7021. The fax line is (888) 267-3277. For Statement of Medical Necessity forms, go directly to Aetna's Specialty Pharmacy Precertification page. Write these numbers into your workflow today — before the September 26, 2025 effective date catches your team off guard.

One thing the CPB 1062 Aetna policy makes clear: this is a commercial plan policy only. If you have Medicare patients, Aetna's Part B criteria page governs those cases. Don't mix up the workflows. A commercial prior auth request submitted through the wrong channel will slow your reimbursement and likely trigger a claim denial.

Coverage Indications at a Glance

Note: The policy data provided does not list detailed indication-level clinical criteria beyond the precertification requirement. Review the full CPB 1062 document at Aetna's provider portal for any indication-specific medical necessity thresholds.

Aetna Tarlatamab-dlle Billing Guidelines and Action Items 2025

Imdelltra billing carries real financial risk if your precert workflow isn't airtight. A single missed prior authorization on a drug that costs tens of thousands of dollars per cycle is not a recoverable billing error — it's a revenue problem. Here's what to do before September 26, 2025.

CPT, HCPCS, and ICD-10 Codes for Tarlatamab-dlle Under CPB 1062

Covered CPT Codes — Chemotherapy and Highly Complex Biologic Administration (When Medical Necessity and Precertification Requirements Are Met)

The policy data lists CPT codes in the 96401 series for chemotherapy and other highly complex drug or highly complex biologic agent administration. These are the codes your billing team uses to report Imdelltra administration. The full range under this policy runs from CPT 96401 through CPT 96480.

The policy data includes 148 CPT codes total. The codes above represent the full range provided. The policy data did not include individual descriptions differentiating each code in this series — use your AMA CPT codebook to confirm which specific administration code (initial, sequential, push, infusion, time-based add-on) applies to each Imdelltra encounter.

Key ICD-10-CM Diagnosis Codes

The policy data references 93 ICD-10-CM codes total. The full list was not provided in the data extract. The policy data confirms these codes are associated with CPB 1062. Pull the complete ICD-10 list from the full CPB 1062 document at Aetna's provider portal to confirm which diagnosis codes support medical necessity for tarlatamab-dlle. Billing without a covered ICD-10 code is a fast path to claim denial, regardless of whether precertification was obtained.

A Note on What CPB 1062 Doesn't Tell You Clearly

The published policy data for this modification is frustratingly thin on clinical criteria detail. It confirms precertification is required and identifies the relevant billing codes. It does not spell out the specific medical necessity thresholds — line-by-line — in the data provided here.

That's not unusual for a biologic agent this new. But it does mean your billing team can't rely on a simple checklist. Your medical director or oncology team should review the full CPB 1062 text directly. If you're billing this drug at volume, loop in your compliance officer before September 26, 2025 to confirm your documentation standards align with Aetna's criteria.