J9299 Insurance Policy Changes

HCPCS J9299 is officially defined as "Injection, nivolumab, 1 mg." HCPCS J9299 is referenced in 10 tracked payer policy changes from Anthem BCBS, BCBS Oklahoma, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9299 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact
[New York] Specialty pharmacy updates — July 2026
Anthem BCBS·Effective Oct 1, 2026
Anthem Blue Cross and Blue Shield is implementing new step therapy requirements for specialty pharmacy medications effective October 1, 2026. Nivolumab (Opdivo) products now require prior authorization review for continued patient use, even if patients are currently receiving these medications without prior auth. Practices must begin requesting prior authorization for these oncology medications on or after the effective date.
High impact
[Virginia] Specialty pharmacy updates — July 2026
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, Anthem Blue Cross and Blue Shield is implementing new step therapy requirements for specialty pharmacy medications in Virginia. Nivolumab (Opdivo) products will now require prior authorization review before patients can continue receiving these medications, even if they are currently on therapy without prior authorization.
Medium impact
[Ohio] Specialty pharmacy updates — July 2026
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, Anthem Blue Cross and Blue Shield in Ohio is implementing new step therapy requirements for specialty pharmacy medications. Patients currently receiving Opdivo (nivolumab, J9299) and Opdivo Qvantig (nivolumab hyaluronidase-nvhy, J9289) without prior authorization will now require prior authorization review for continued use. Providers must request prior authorization for these medications on or after the effective date.
Medium impact
[Georgia] Specialty pharmacy updates — July 2026
Anthem BCBS·Effective Oct 1, 2026
Effective October 1, 2026, Anthem Blue Cross and Blue Shield is implementing new step therapy requirements for specialty pharmacy medications, specifically nivolumab (Opdivo) products. Patients currently receiving these medications without prior authorization will now require prior authorization review for continued use. Two formulations are affected: nivolumab (J9299, preferred) and nivolumab hyaluronidase-nvhy (J9289, non-preferred).
High impact
New Claims Editing Rules To Be Implemented in July 2026
BCBS Oklahoma·Effective Jul 15, 2026
New claims editing rules will be implemented in July 2026 affecting multiple procedure codes and billing scenarios. These automated edits will result in claim denials or payment adjustments for various issues including missing modifiers, incorrect diagnosis sequencing, and inappropriate code combinations.
High impact
New Claims Editing Rules To Be Implemented in July 2026
BCBS Montana·Effective Jul 15, 2026
Blue Cross Blue Shield of Montana is implementing 18 new automated claims editing rules in their Lyric software database effective July 15, 2026. These rules will automatically deny or rebundle claims that don't meet specific coding requirements, with denials showing reason codes beginning with 'G'.
High impact
New Claims Editing Rules To Be Implemented in July 2026
BCBS New Mexico·Effective Jul 15, 2026
Blue Cross Blue Shield of New Mexico is implementing comprehensive claims editing rules in July 2026 that will automatically deny or rebundle claims with coding errors, affecting radiation therapy, STI testing, colonoscopies, hospital services, and many other procedures. Claims receiving edits will show ineligible reason codes starting with 'G'.
High impact
New Claims Editing Rules To Be Implemented in July 2026
BCBS Illinois·Effective Jul 15, 2026
Blue Cross Blue Shield of Illinois will implement 18 new claims editing rules in July 2026 that will automatically deny or rebundle claims with specific coding errors, including radiation therapy planning, STI testing combinations, colonoscopy injections, and missing modifiers. Claims receiving these edits will show reason codes with 'G' alpha characters.
High impact
New Claims Editing Rules To Be Implemented in July 2026
BCBS Texas·Effective Jul 15, 2026
Blue Cross Blue Shield of Texas is implementing new claims editing rules in July 2026 that will automatically deny or rebundle claims for various coding scenarios. Claims receiving these edits will show ineligible reason codes with an alpha character 'G' and affect multiple specialties including radiation therapy, STI testing, colonoscopy procedures, and hospital billing.
High impact
Oncology drug dose rounding program: July 7 drug list update
Cigna·Effective Jul 7, 2025
Cigna Healthcare is adding 9 new oncology drugs to their dose rounding program effective July 7, 2025. The program rounds drug doses down to the nearest vial size when within 5-10% of prescribed dose, and all prior authorizations are managed through EviCore.

Related

All billing codes J3590 99212 99213 99202 99211 99214

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