Medicare AdvantageAdministrativeLow impact
MA08.145a, Sutimlimab-jome (Enjaymo)
Independence Blue Cross·NJ · Hematology, Pharmacy·Pharmacy
We identified it
Jul 23, 2026
Summary
This is a reissue with no material changes to MA08.145a. Independence Blue Cross Medicare Advantage has reviewed and reconfirmed its continuing coverage position for sutimlimab-jome (Enjaymo) for hemolysis treatment in cold agglutinin disease. The policy maintains existing medical necessity criteria, HCPCS code J1302, and coverage requirements. No billing workflow changes are needed.
Action Required
No action required. This is a reissue with no changes to the policy. Billing team should verify that system configurations for HCPCS code J1302 (Injection, sutimlimab-jome, 10 mg) remain current and that prior authorization workflows for cold agglutinin disease cases (ICD-10: D59.12) are properly configured to reflect the documented medical necessity criteria outlined in the policy. No updates to billing processes or documentation requirements are necessary.