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Blue Cross & Blue Shield of MississippiCommercial · Coverage · Medical Policy · MS · Infectious Disease, Dermatology, Emergency Medicine +2 moreMedium impact

State and School Employees' Health Insurance Plan - Kimyrsa (oritavancin)

Act
by Nov 1, 2025
Effective date
Nov 1, 2025
Identified
Jun 20, 2026

Summary

The State and School Employees' Health Insurance Plan has added a new policy effective November 1, 2025, declaring Kimyrsa (oritavancin) as not medically necessary for treating bacterial skin infections. Claims for CPT code J2406 and related administration services will be denied as the plan considers other covered treatment options sufficient.

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What to do

by Nov 1, 2025 · 3 steps
01Billing team must update system to flag CPT code J2406 (oritavancin injection) as non-covered for State and School Employees' Health Plan members.
02Alert providers that Kimyrsa and its administration will be denied.
03Verify alternative covered antibiotics are available on the plan formulary before treating bacterial skin infections.

Codes mentioned

J2406

Original notice

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

Related changes

See all Blue Cross & Blue Shield of Mississippi changes →
Kimyrsa (oritavancin)MediumEffective Nov 1, 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 changesInfectious DiseaseDermatologyEmergency MedicineInternal MedicineFamily MedicineCode J2406

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