CommercialBilling CodesMedium impact
Medical Criteria Update for April 6, 2022
Blue Cross NC·NC · Oncology, Hematology, Rheumatology +2 more·Medical Policy
Effective date
Apr 6, 2022
We identified it
Jun 16, 2026
Summary
Blue Cross NC updated their medical criteria to add five new specialty drugs with associated HCPCS codes (Nexviazyme, Saphnelo, Tezspire, Enjaymo, and Leqvio) and updated the HCPCS code for Evkeeza from a temporary code to permanent code J1305. These changes provide clarity for billing these specialty medications.
Action Required
Immediately: Billing team must update drug billing system to use permanent HCPCS code J1305 for Evkeeza instead of temporary codes. Add the five new specialty drugs (Nexviazyme, Saphnelo, Tezspire, Enjaymo, Leqvio) with their respective HCPCS codes to the billing system if administering these medications. Verify individual drug policies for specific prior authorization requirements.