Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-08-05)

IMMEDIATE: Billing team must implement mandatory precertification protocol for all amivantamab claims. (1) Update billing system to flag ALL claims for Rybrevant (J9061) and Rybrevant Faspro requiring prior authorization before submission. (2) For all NSCLC cases (ICD-10 C34.00-C34.92), establish precertification workflow: Call (866) 752-7021 or fax (888) 267-3277 before treatment initiation. (3) Verify EGFR mutation status (CPT 81235) is documented and matches one of three approved mutations (Exon 19 Deletion, Exon 21 L858R, or Exon 20 Insertion) before authorization approval. (4) Confirm treatment combination matches policy criteria (lazertinib, carboplatin/pemetrexed, or single agent) and dosing aligns with body weight tables provided. (5) Update encounter forms and prior auth templates to capture baseline body weight for dose calculation accuracy. (6) Train providers on site-of-service requirements for Rybrevant Faspro (subcutaneous administration). (7) Flag any requests for gastro-esophageal cancer (C15.3-C15.9, C16.0-C16.9) or other non-NSCLC indications for denial as experimental/investigational. Failure to obtain precertification will result in claim denials. Continuation of therapy requires reauthorization demonstrating no unacceptable toxicity or disease progression.