Anthem updated its bevacizumab non‑ophthalmologic clinical criteria (CC-0107) effective 2026-03-01 to incorporate NCCN 2A recommendations for select soft tissue sarcomas. Bevacizumab is specified as covered as a single agent for angiosarcoma and in combination with temozolomide for solitary fibrous tumor, both retained at NCCN 2A (consensus but not highest-level evidence). The revision appears in the broader bevacizumab indication table alongside other tumor-specific requirements and includes updated HCPCS/Q-code mapping for bevacizumab biosimilars and related coding notes. Providers should use the listed ICD-10 ranges (e.g., C49.0–C49.9) and the specified regimen contexts when submitting authorization requests.
March 2026 Revision: Bevacizumab Soft Tissue Sarcoma Criteria (NCCN 2A)
This revision reflects the policy text effective 2026-03-01 for Anthem's Medical Drug Clinical Criteria CC-0107 specific to bevacizumab non-ophthalmologic uses. The document reiterates and incorporates NCCN-based recommendations for multiple tumor types, including updated language on soft tissue sarcoma that aligns with NCCN 2A guidance. The policy explicitly lists bevacizumab use as a single agent for angiosarcoma and in combination with temozolomide for solitary fibrous tumor as covered indications under the soft tissue sarcoma section.
Document history entries included with this revision show prior updates (most recently 07/25/2022, 05/20/2022, and earlier dates) where the policy was aligned to NCCN changes, agent additions (e.g., Alymsys), and coding reviews. The current effective text preserves the NCCN 2A classification for these soft tissue sarcoma indications rather than elevating them to NCCN 1.
Specified Indications: `angiosarcoma` and `solitary fibrous tumor`
The policy defines specific covered uses for bevacizumab in soft tissue sarcoma. For angiosarcoma, bevacizumab is described as appropriate when used as a single agent, reflecting NCCN recommendation. For solitary fibrous tumor, bevacizumab is recognized when used in combination with temozolomide. Both uses are cited as NCCN 2A, indicating consensus but not the highest level of evidence.
This coverage is presented alongside other systemic oncology indications in the policy (e.g., hepatocellular carcinoma, renal cell carcinoma), but the soft tissue sarcoma section is narrowly focused on these two histologies and specific regimen contexts rather than broad, histology-agnostic use.
Context in Broader Bevacizumab Indication Table and NCCN Alignment
The policy text situates the soft tissue sarcoma guidance within a larger framework of labeled and NCCN-supported bevacizumab uses. It lists multiple tumor types for which bevacizumab and its biosimilars are considered (e.g., small bowel adenocarcinoma, hepatocellular carcinoma, various other malignancies) and explicitly marks soft tissue sarcoma among those indications attributed as Y (yes) for available bevacizumab products.
The policy also cross-references other detailed criteria for different malignancies (e.g., hepatocellular carcinoma requirements including Child-Pugh class and ECOG status; renal cell carcinoma combinations with interferon or targeted agents). This context underscores that the soft tissue sarcoma recommendations are part of a comprehensive non-ophthalmologic bevacizumab coverage matrix.
Coding and Diagnosis Mappings for Bevacizumab and Biosimilars
The document includes coding guidance for bevacizumab and its biosimilars with specific HCPCS/Q-codes: Q5107 (Mvasi), Q5118 (Zirabev), Q5126 (Alymsys), Q5129 (Vegzelma), Q5160 (Jobevne), and references to product names including Avastin and others. ICD-10 diagnosis code ranges listed encompass soft tissue and related malignancies (e.g., C49.0-C49.9 for malignant neoplasm of other connective and soft tissue) and other tumor types referenced elsewhere in the policy.
Document history notes also record periodic coding reviews and additions (e.g., HCPCS J9999, J3490, J3590, C9399) during prior updates, indicating ongoing maintenance of billing and mapping information concurrent with clinical criteria changes.
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