Medicare AdvantageBilling CodesMedium impact
MA08.083m, Leuprolide (Camcevi™, Camcevi ETM®, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross·Oncology, Urology·Pharmacy
Effective date
Jul 13, 2026
We identified it
Jul 14, 2026
Summary
Independence Blue Cross updated MA08.083m to MA08.083n, adding Camcevi ETM® 21 mg (a newly FDA-approved 3-month leuprolide formulation) to the leuprolide policy for advanced prostate cancer. New HCPCS code J9003 has been added to represent this formulation. The policy maintains preferred product status for leuprolide acetate (Eligard and Lupron Depot 7.5 mg, HCPCS J9217) while Camcevi ETM remains a non-preferred product covered only for members with prior non-preferred product history.
Action Required
By July 13, 2026: Billing team must update billing system and claims software to recognize new HCPCS code J9003 (Leuprolide injectable Camcevi ETM, 1 mg) for Independence Blue Cross Medicare Advantage members. Implement coverage logic requiring prior non-preferred product history before authorizing J9003 claims for prostate cancer and salivary gland tumors. Update encounter forms and prior authorization workflows to reflect that J9003 is non-preferred and subject to step-therapy requirements. Verify that preferred product codes J9217 (Eligard/Lupron Depot 7.5 mg) and J1951 (Fensolvi) continue to process without additional restrictions. Train billing and coding staff on the new formulation and its coding distinction. Claims submitted without proper prior non-preferred product documentation will be denied.