What insurance policy changes affect HCPCS J9361?

There are 9 tracked policy changes affecting HCPCS J9361, including updates from Arkansas Blue Cross Blue Shield, BCBS Tennessee, Florida Blue. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J9361?

Payers that have issued tracked updates for HCPCS J9361 include: Arkansas Blue Cross Blue Shield, BCBS Tennessee, Florida Blue, Nevada Medicaid, Capital Blue Cross, Texas Medicaid, Blue Cross & Blue Shield of Mississippi.

How do I get notified when HCPCS J9361 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J9361. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS J9361?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

J9361 — Injection, efbemalenograstim alfa-vuxw, 0.5 mg: Insurance Policy Changes

J9361 Insurance Policy Changes

HCPCS J9361 is officially defined as "Injection, efbemalenograstim alfa-vuxw, 0.5 mg." HCPCS J9361 is referenced in 9 tracked payer policy changes from Arkansas Blue Cross Blue Shield, BCBS Tennessee, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9361 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Policy Criteria Change

Arkansas Blue Cross Blue Shield·Effective Sep 17, 2026

Arkansas Blue Cross updated coverage criteria for five specialty medications (Duopa, Adstiladrin, Imaavy, Vyvgart, Vyvgart Hytrulo) and restructured white blood cell growth factor coverage with new preferred/non-preferred product lists and clinical criteria for febrile neutropenia prophylaxis. Key changes include removal of acetylcholine receptor positivity requirements for efgartigimod products, addition of off-label bladder cancer criteria for nadofaragene firadenovec-vncg, and comprehensive updates to WBC growth factor authorization rules based on chemotherapy risk stratification.

J9361 Insurance Policy Changes

Policy Criteria Change

Commercial BlueCare PAD_Step Therapy Guide

Medicare Part B Step Therapy Product Updates

Pharmacy Codes Open for Billing

AB2026-03-002 Medicare only

February 2026 TMPPM Update for Colony Stimulating Factors

State and School Employees' Health Insurance Plan - Ryzneuta (efbemalenograstim alfa-vuxw)

Ryzneuta (efbemalenograstim alfa-vuxw)

Updated Category for Medicare Advantage Part B Step Therapy