Medicare AdvantageJune 27, 2025
Specialty pharmacy precertification list expanded
Effective for dates of service on and after November 1, 2025, the specialty Medicare Part B drug listed in the table below will be included in our precertification review process.
HCPCS codes | Medicare Part B drugs |
C9399, J9999 | Axtle (pemetrexed) |
C9399, J9999 | Bizengri (zenocutuzumab‑zbco) |
C9399, J3490 | Bynfezia pen (octreotide acetate) |
Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may prevent claims from being approved.
Anthem Blue Cross and Blue Shield is the trade name of Blue Cross Blue Shield of Wisconsin (BCBSWI), Compcare Health Services Insurance Corporation (Compcare), and Wisconsin Collaborative Insurance Company (WCIC). BCBSWI underwrites or administers PPO and indemnity policies and underwrites the out of network benefits in POS policies offered by Compcare or WCIC; Compcare underwrites or administers HMO or POS policies; WCIC underwrites or administers Well Priority HMO or POS policies. Independent licensee(s) of the Blue Cross Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
MULTI-BCBS-CR-084101-25-CPN83702
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