Traditional MedicarePrior AuthMedium impact
Lynozyfic (linvoseltamab-gcpt) (Revised)
Humana·KY, SC · Hematology, Oncology·Medicaid
We identified it
Jul 21, 2026
Summary
This is a revised Prior Authorization policy for Lynozyfic (linvoseltamab-gcpt), a newly approved biologic treatment. The policy establishes prior authorization requirements for Medicare, Medicaid - Kentucky, and Medicaid - South Carolina members. Billing teams must implement prior auth verification before claims submission for affected populations.
Action Required
Immediately: Billing team must obtain the complete policy document from the source URL (https://dctm.humana.com/Mentor/Web/v.aspx?objectID=090009298a584820) to identify specific HCPCS/NDC codes for Lynozyfic and any applicable CPT codes. Update billing software to require prior authorization submission before processing claims for Kentucky and South Carolina Medicaid members and Medicare beneficiaries. Add Lynozyfic to the prior auth checklist in the EMR and ensure providers are notified of authorization requirements. Establish a process to track prior auth requests and denials. Claims submitted without required prior authorization will be denied and may require resubmission.