HCPCS J9028 is officially defined as "Injection, nogapendekin alfa inbakicept-pmln, for intravesical use, 1 microgram." HCPCS J9028 is referenced in 4 tracked payer policy changes from BCBS Michigan, Premera Blue Cross, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9028 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.
Starting May 13, 2026, Blue Cross Blue Shield of Michigan and Blue Care Network are adding prior authorization, site of care, and step therapy requirements for 7 medical oncology drugs administered in outpatient settings. Additionally, step therapy requirements for Anktiva are being expanded to require failure of two drugs instead of one.
Blue Cross Blue Shield of Michigan is adding prior authorization, site of care, and step therapy requirements for seven medical oncology drugs effective May 13, 2026. The policy also updates step therapy requirements for Anktiva to require trying two drugs instead of one.
Premera's January 2025 update adds Carelon imaging, genetic testing and radiation oncology guideline changes for dates of service on and after April 20, 2025, and adds new Insulin Therapy and SGLT2 Inhibitors pharmacy policies effective January 1, 2025. It also adds Kisunla to the amyloid antibody policy and lists coding updates that now require review for medical necessity and prior authorization, including amyloid antibody code J0175, folate antimetabolite code J9292, and sickle cell disease code J3392.
Already effective July 1, 2025, Louisiana Blue accepts only the CAQH application for professional credentialing and recredentialing, and the Louisiana Standardized Credentialing Application was accepted for participating providers until June 30. Added codes in the Diagnostic and Therapeutic Services and Outpatient Procedure Services code ranges have effective dates of January 1, 2025 and April 1, 2025, including 15013, 15014, 38226 and 38227. For infusion therapy, the prior authorization must include all codes billed, including administration codes, or penalties will be applied to the claim.
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