CommercialBilling CodesMedium impact
08.01.33m, Leuprolide (Camcevi™, Camcevi ETM®, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross·PA · Oncology, Urology, Pharmacy·Pharmacy
Effective date
Jul 13, 2026
We identified it
Jul 14, 2026
Summary
Independence Blue Cross added Camcevi ETM® 21 mg (a new 3-month leuprolide formulation) to policy 08.01.33m, effective 07/13/2026. This requires billing teams to recognize new HCPCS code J9003 and expanded ICD-10 codes for cervical cancer indications. The policy maintains leuprolide acetate (Eligard/Lupron Depot 7.5 mg, J9217) as the preferred product for prostate cancer and salivary gland tumors, with nonpreferred products requiring prior authorization or documented contraindication/intolerance.
Action Required
By 07/13/2026: (1) Billing team must update billing system to recognize HCPCS code J9003 (Leuprolide injectable Camcevi ETM, 1 mg) for reimbursement. (2) Add ICD-10 codes C53.8 and C53.9 (cervical cancer diagnoses) to the system's coverage criteria for J9003, J9217, J1950, J1951, and J1952. (3) Update prior authorization workflows to ensure nonpreferred leuprolide products (J1952, J9003, J1950) require either patient history of nonpreferred product use or documented contraindication/intolerance to preferred product (J9217) before authorization. (4) Educate clinical and billing staff that Camcevi ETM is now a covered nonpreferred product, requiring the same authorization logic as other nonpreferred formulations. (5) Configure system edits to flag claims using J9003 without prior auth authorization documentation, which will result in denial.