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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Infectious Disease, Critical Care, Pulmonology +1 moreMedium impact

State and School Employees' Health Insurance Plan - Recarbrio (imipenem-cliastatin-relebactam)

Act
immediately
Effective date
Not stated in the notice
Identified
Jun 20, 2026

Summary

Mississippi's State and School Employees' Health Insurance Plan has updated their policy to consider Recarbrio (imipenem-cilastatin-relebactam) not medically necessary for all approved indications, including hospital-acquired pneumonia and complicated infections. The drug is only covered when patients have limited or no alternative treatment options for certain conditions.

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What to do

immediately · 3 steps
01Billing team must update system to flag HCPCS code J0742 (Recarbrio injection) as requiring documentation of limited or no alternative treatment options for complicated UTI and intra-abdominal infections.
02For hospital-acquired pneumonia and ventilator-associated pneumonia, claims will likely be denied as not medically necessary.
03Providers must document exhaustion of covered alternatives before using Recarbrio.

Codes mentioned

J0742

Original notice

State and School Employees' Health Insurance Plan - Recarbrio (imipenem-cliastatin-relebactam)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Recarbrio (imipenem-cilastatin-relebactam)MediumNo effective date · Medical PolicyBrowse every Blue Cross & Blue Shield of Mississippi change in the policy list

Related policy hubs

Blue Cross & Blue Shield of Mississippi policiesMS policy changesInfectious DiseaseCritical CarePulmonologyUrologyCode J0742

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