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Atezolizumab (Tecentriq®)
BCBS Tennessee·Oncology, Hematology, Pulmonology +1 more·Medical Policy
Effective date
Sep 30, 2026
We identified it
Jul 17, 2026
Summary
This is a new comprehensive medical policy for Atezolizumab (Tecentriq®) that establishes coverage criteria, prior authorization requirements, and documentation standards across multiple cancer indications including NSCLC, SCLC, HCC, melanoma, mesothelioma, and others. The policy requires prior authorization with specific genetic/molecular testing documentation and grants 6-month authorization periods for covered indications. Do NOT implement until 9/30/26.
Action Required
By September 30, 2026: Billing team must implement prior authorization requirements for Atezolizumab (Tecentriq®) HCPCS code J9023 across all covered cancer indications. Update billing system to require submission of genetic/molecular testing documentation (PD-L1 expression, BRAF V600 mutation, EGFR/ALK/RET/ROS1 status, MSI-H/dMMR/POLE/POLD1 status as applicable per indication) before claim processing. Configure system to grant 6-month authorization periods and enforce exclusion for members with prior PD-1/PD-L1 inhibitor progression. Coordinate with oncology providers to ensure required test results are obtained and documented with prior authorization requests. Create encounter form checklist for oncology teams to ensure all required documentation is submitted with each prior authorization request. Claims submitted without required documentation will be denied. Educate billing staff and providers on specific coverage criteria for each indication (NSCLC adjuvant vs. metastatic, SCLC extensive-stage, HCC unresectable/metastatic, etc.) to ensure appropriate authorization coding.