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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Psychiatry, Emergency MedicineMedium impact

Igalmi (dexmedetomidine)

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

Summary

BCBS Mississippi has updated their policy for Igalmi (dexmedetomidine) to classify it as not medically necessary, adding specific billing code J1105 to their not medically necessary codes list. The policy now includes enhanced documentation requirements and clarifies that services related to delivery/administration will also be denied if the medication hasn't been approved through prior authorization.

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What to do

immediately · 4 steps
01Billing team must flag HCPCS code J1105 (dexmedetomidine, oral, 1 mcg) as not covered by BCBS Mississippi.
02Update billing system to prevent submission of claims with this code.
03For State Health Plan members, verify coverage through CVS Caremark formulary at https://www.dfa.ms.gov/cvs-caremark before billing.
04Claims submitted with J1105 will be denied as not medically necessary.

Codes mentioned

J1105

Original notice

Igalmi (dexmedetomidine)
bcbsms.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
State and School Employees' Health Insurance Plan - Igalmi (dexmedetomidine)MediumEffective Nov 15, 2025 · 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 changesPsychiatryEmergency MedicineCode J1105

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