When does this change take effect?

This change is effective Sep 14, 2026.

What do I need to do?

Already effective 09/14/2026: Billing team should confirm that tocilizumab IV claims use the revised criteria. Add the ICD-10 diagnosis codes the policy now lists as medically necessary (the C46, C90, C91, D47.Z2, D89.8, G92.0 and M05 and M06 series; the source text is cut off partway through the M06 series, so check the full list in the policy) to the diagnosis options in charge entry, and make sure the chart supports the criteria for each indication. For COVID-19, the hospitalized criteria now include patients 2 years of age and older, so update the COVID-19 charge set-up and documentation for pediatric patients. For rheumatoid arthritis and juvenile idiopathic arthritis, the revised criteria should be checked against the chart before billing. Providers should be told that tocilizumab should be avoided in combination with biologic DMARDs such as TNF antagonists, IL-1R antagonists, anti-CD20 antibodies and selective co-stimulation modulators. For nonpreferred products (Actemra IV, Tofidence IV, and other nonpreferred biosimilars), document a contraindication, an intolerance, or an inadequate response to the preferred Tyenne IV or Avtozma IV in the chart, because the policy covers nonpreferred products only with that documentation. For CAR T-cell patients, providers should record CRS and neurotoxicity grades using the CTCAE v5.0 criteria in the note, since the policy now uses those criteria. Watch for Independence Blue Cross's next pharmacy policy update.

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Independence Blue CrossCommercial · Coverage · Pharmacy · Rheumatology, Oncology, Hematology +3 moreHigh impact

08.00.85u, Tocilizumab and Related Biosimilars for Intravenous Infusion

Q: Who is affected by this change?

This affects Independence Blue Cross Rheumatology, Oncology, Hematology, Pharmacy, Pediatrics, Infectious Disease providers on Commercial plans.

Q: Which billing codes are affected?

The following codes are affected: J3262, M0231, M0232, C46.0, C46.1, C46.2, C46.3, C46.4, C46.50, C46.51, C46.52, C46.7, C46.9, C90.00, C90.01, C90.02, C90.10, C90.11, C90.12, C90.20, C90.21, C90.22, C90.30, C90.31, C90.32, C91.00, C91.01, C91.02, D47.Z2, D89.810, D89.831, D89.832, D89.833, D89.834, D89.839, G92.01, G92.02, G92.03, G92.04, M05.00, M05.011, M05.012, M05.021, M05.022, M05.031, M05.032, M05.041, M05.042, M05.051, M05.052, M05.061, M05.062, M05.071, M05.072, M05.09, M05.10, M05.111, M05.112, M05.121, M05.122, M05.131, M05.132, M05.141, M05.142, M05.151, M05.152, M05.161, M05.162, M05.171, M05.172, M05.19, M05.20, M05.211, M05.212, M05.221, M05.222, M05.231, M05.232, M05.241, M05.242, M05.251, M05.252, M05.261, M05.262, M05.271, M05.272, M05.29, M05.30, M05.311, M05.312, M05.321, M05.322, M05.331, M05.332, M05.341, M05.342, M05.351, M05.352, M05.361, M05.362, M05.371, M05.372, M05.39, M05.40, M05.411, M05.412, M05.421, M05.422, M05.431, M05.432, M05.441, M05.442, M05.451, M05.452, M05.461, M05.462, M05.471, M05.472, M05.49, M05.50, M05.511, M05.512, M05.521, M05.522, M05.531, M05.532, M05.541, M05.542, M05.551, M05.552, M05.561, M05.562, M05.571, M05.572, M05.59, M05.60, M05.611, M05.612, M05.621, M05.622, M05.631, M05.632, M05.641, M05.642, M05.651, M05.652, M05.661, M05.662, M05.671, M05.672, M05.69, M05.7A, M05.8A, M05.70, M05.711, M05.712, M05.721, M05.722, M05.731, M05.732, M05.741, M05.742, M05.751, M05.752, M05.761, M05.762, M05.771, M05.772, M05.79, M05.80, M05.811, M05.812, M05.821, M05.822, M05.831, M05.832, M05.841, M05.842, M05.851, M05.852, M05.861, M05.862, M05.871, M05.872, M05.89, M05.9, M06.0A, M06.8A, M06.00, M06.011.

Effective date

Sep 14, 2026

Identified

Sep 15, 2026

Summary

Independence Blue Cross Commercial policy 08.00.85u on tocilizumab IV products and biosimilars was updated to take effect 09/14/2026, which is already in effect as of today. It revises the CAR T-cell toxicity criteria, adds criteria for Kaposi sarcoma-associated inflammatory cytokine syndrome, extends the hospitalized COVID-19 criteria to children age 2 and older, revises the juvenile idiopathic arthritis and rheumatoid arthritis criteria, and adds a long list of ICD-10 diagnosis codes as medically necessary. Because the source is a notice from the payer's own bulletin, confirm the current version with Independence Blue Cross before relying on it.

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What to do

Action · 8 steps

01Already effective 09/14/2026: Billing team should confirm that tocilizumab IV claims use the revised criteria.

02Add the ICD-10 diagnosis codes the policy now lists as medically necessary (the C46, C90, C91, D47.Z2, D89.8, G92.0 and M05 and M06 series; the source text is cut off partway through the M06 series, so check the full list in the policy) to the diagnosis options in charge entry, and make sure the chart supports the criteria for each indication.

03For COVID-19, the hospitalized criteria now include patients 2 years of age and older, so update the COVID-19 charge set-up and documentation for pediatric patients.

04For rheumatoid arthritis and juvenile idiopathic arthritis, the revised criteria should be checked against the chart before billing.

05Providers should be told that tocilizumab should be avoided in combination with biologic DMARDs such as TNF antagonists, IL-1R antagonists, anti-CD20 antibodies and selective co-stimulation modulators.

06For nonpreferred products (Actemra IV, Tofidence IV, and other nonpreferred biosimilars), document a contraindication, an intolerance, or an inadequate response to the preferred Tyenne IV or Avtozma IV in the chart, because the policy covers nonpreferred products only with that documentation.

07For CAR T-cell patients, providers should record CRS and neurotoxicity grades using the CTCAE v5.0 criteria in the note, since the policy now uses those criteria.

08Watch for Independence Blue Cross's next pharmacy policy update.

Codes mentioned

J3262M0231M0232C46.0C46.1C46.2C46.3C46.4C46.50C46.51C46.52C46.7C46.9C90.00C90.01C90.02C90.10C90.11C90.12C90.20C90.21C90.22C90.30C90.31C90.32C91.00C91.01C91.02D47.Z2D89.810D89.831D89.832D89.833D89.834D89.839G92.01G92.02G92.03G92.04M05.00M05.011M05.012M05.021M05.022M05.031M05.032M05.041M05.042M05.051M05.052M05.061M05.062M05.071M05.072M05.09M05.10M05.111M05.112M05.121M05.122M05.131M05.132M05.141M05.142M05.151M05.152M05.161M05.162M05.171M05.172M05.19M05.20M05.211M05.212M05.221M05.222M05.231M05.232M05.241M05.242M05.251M05.252M05.261M05.262M05.271M05.272M05.29M05.30M05.311M05.312M05.321M05.322M05.331M05.332M05.341M05.342M05.351M05.352M05.361M05.362M05.371M05.372M05.39M05.40M05.411M05.412M05.421M05.422M05.431M05.432M05.441M05.442M05.451M05.452M05.461M05.462M05.471M05.472M05.49M05.50M05.511M05.512M05.521M05.522M05.531M05.532M05.541M05.542M05.551M05.552M05.561M05.562M05.571M05.572M05.59M05.60M05.611M05.612M05.621M05.622M05.631M05.632M05.641M05.642M05.651M05.652M05.661M05.662M05.671M05.672M05.69M05.7AM05.8AM05.70M05.711M05.712M05.721M05.722M05.731M05.732M05.741M05.742M05.751M05.752M05.761M05.762M05.771M05.772M05.79M05.80M05.811M05.812M05.821M05.822M05.831M05.832M05.841M05.842M05.851M05.852M05.861M05.862M05.871M05.872M05.89M05.9M06.0AM06.8AM06.00M06.011

Original notice

08.00.85u, Tocilizumab and Related Biosimilars for Intravenous Infusion

medpolicy.ibx.com · Always check the source before changing claims.

View original ↗

MA08.045r, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Sep 21, 2026 · Pharmacy MA08.188b, Linvoseltamab-gcpt (Lynozyfic)MediumEffective Apr 1, 2026 · Pharmacy 08.02.47b, linvoseltamab-gcpt (Lynozyfic™)MediumEffective Apr 1, 2026 · Pharmacy MA08.188a, Linvoseltamab-gcpt (Lynozyfic)HighEffective Jan 1, 2026 · Pharmacy Browse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policies Rheumatology Oncology Hematology Pharmacy Pediatrics Infectious Disease Code J3262 Code M0231 Code M0232 Code C46.0 Code C46.1 Code C46.2 Code C46.3 Code C46.4 Code C46.50 Code C46.51 Code C46.52 Code C46.7 Code C46.9 Code C90.00 Code C90.01 Code C90.02 Code C90.10 Code C90.11 Code C90.12 Code C90.20 Code C90.21 Code C90.22 Code C90.30 Code C90.31 Code C90.32 Code C91.00 Code C91.01 Code C91.02 Code D47.Z2 Code D89.810 Code D89.831 Code D89.832 Code D89.833 Code D89.834 Code D89.839 Code G92.01 Code G92.02 Code G92.03 Code G92.04 Code M05.00 Code M05.011 Code M05.012 Code M05.021 Code M05.022 Code M05.031 Code M05.032 Code M05.041 Code M05.042 Code M05.051 Code M05.052 Code M05.061 Code M05.062 Code M05.071 Code M05.072 Code M05.09 Code M05.10 Code M05.111 Code M05.112 Code M05.121 Code M05.122 Code M05.131 Code M05.132 Code M05.141 Code M05.142 Code M05.151 Code M05.152 Code M05.161 Code M05.162 Code M05.171 Code M05.172 Code M05.19 Code M05.20 Code M05.211 Code M05.212 Code M05.221 Code M05.222 Code M05.231 Code M05.232 Code M05.241 Code M05.242 Code M05.251 Code M05.252 Code M05.261 Code M05.262 Code M05.271 Code M05.272 Code M05.29 Code M05.30 Code M05.311 Code M05.312 Code M05.321 Code M05.322 Code M05.331 Code M05.332 Code M05.341 Code M05.342 Code M05.351 Code M05.352 Code M05.361 Code M05.362 Code M05.371 Code M05.372 Code M05.39 Code M05.40 Code M05.411 Code M05.412 Code M05.421 Code M05.422 Code M05.431 Code M05.432 Code M05.441 Code M05.442 Code M05.451 Code M05.452 Code M05.461 Code M05.462 Code M05.471 Code M05.472 Code M05.49 Code M05.50 Code M05.511 Code M05.512 Code M05.521 Code M05.522 Code M05.531 Code M05.532 Code M05.541 Code M05.542 Code M05.551 Code M05.552 Code M05.561 Code M05.562 Code M05.571 Code M05.572 Code M05.59 Code M05.60 Code M05.611 Code M05.612 Code M05.621 Code M05.622 Code M05.631 Code M05.632 Code M05.641 Code M05.642 Code M05.651 Code M05.652 Code M05.661 Code M05.662 Code M05.671 Code M05.672 Code M05.69 Code M05.7A Code M05.8A Code M05.70 Code M05.711 Code M05.712 Code M05.721 Code M05.722 Code M05.731 Code M05.732 Code M05.741 Code M05.742 Code M05.751 Code M05.752 Code M05.761 Code M05.762 Code M05.771 Code M05.772 Code M05.79 Code M05.80 Code M05.811 Code M05.812 Code M05.821 Code M05.822 Code M05.831 Code M05.832 Code M05.841 Code M05.842 Code M05.851 Code M05.852 Code M05.861 Code M05.862 Code M05.871 Code M05.872 Code M05.89 Code M05.9 Code M06.0A Code M06.8A Code M06.00 Code M06.011

08.00.85u, Tocilizumab and Related Biosimilars for Intravenous Infusion

Summary

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What to do

Codes mentioned

Original notice

Related changes

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