CommercialCoverageMedium impact
State and School Employees' Health Insurance Plan - Qutenza (capsaicin kit)
Blue Cross & Blue Shield of Mississippi·MS · Pain Management, Neurology, Endocrinology +3 more·Medical Policy
Effective date
Nov 1, 2025
We identified it
Jun 20, 2026
Summary
Mississippi State and School Employees' Health Insurance Plan has issued a new policy effective November 1, 2025, declaring Qutenza (8% capsaicin patch) not medically necessary for treating neuropathic pain from postherpetic neuralgia and diabetic peripheral neuropathy. All services related to delivery and administration of Qutenza will also be denied as not medically necessary.
Action Required
Immediately: Billing team must update system to flag HCPCS code J7336 (Capsaicin 8% patch) as non-covered for Mississippi State and School Employees' Health Insurance Plan members. Update encounter forms to alert providers that Qutenza is not covered and alternative treatments should be considered. Claims for J7336 and related administration services will be denied for this specific plan.