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Blue Cross NCCommercial · Billing Codes · Medical Policy · NC · Oncology, Hematology, Rheumatology +2 moreMedium impact

Medical Criteria Update for April 6, 2022

Act
immediately
Effective date
Apr 6, 2022
Identified
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.

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What to do

immediately · 3 steps
01Billing team must update drug billing system to use permanent HCPCS code J1305 for Evkeeza instead of temporary codes.
02Add the five new specialty drugs (Nexviazyme, Saphnelo, Tezspire, Enjaymo, Leqvio) with their respective HCPCS codes to the billing system if administering these medications.
03Verify individual drug policies for specific prior authorization requirements.

Codes mentioned

C9085J3490J3590C9086C9399J1305

Original notice

Medical Criteria Update for April 6, 2022
bluecrossnc.com · Always check the source before changing claims.
View original ↗

Related changes

See all Blue Cross NC changes →
Medical Policy Update for December 29, 2023HighEffective Jan 1, 2024 · Medical PolicyMedical Policy Update for May 2, 2023MediumEffective May 2, 2023 · Medical PolicyMedical Policy Update for April 1, 2024MediumEffective Apr 1, 2024 · Medical PolicyBrowse every Blue Cross NC change in the policy list

Related policy hubs

Blue Cross NC policiesNC policy changesOncologyHematologyRheumatologyEndocrinologyCardiologyCode C9085Code J3490Code J3590Code C9086Code C9399Code J1305

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