Medicare AdvantageBilling CodesMedium impact
MA08.029d, Natalizumab (Tysabri®) and Related Biosimilars
Independence Blue Cross·Neurology, Gastroenterology, Pharmacy·Pharmacy
Effective date
Oct 1, 2025
We identified it
Oct 2, 2026
Summary
Independence Blue Cross reissued MA08.029d with no substantive coverage changes to the natalizumab (Tysabri) and biosimilar policy. However, ICD-10 diagnosis codes were refined: the broad code G35 (Multiple sclerosis) was replaced with three specific codes (G35.A, G35.C1, G35.D) to align with current MS classification. Billing teams must update diagnosis code mapping to ensure claims use the new specific codes rather than the removed general code.
Action Required
By October 1, 2025: Billing team must update diagnosis code mapping in billing software and claim submission systems to remove G35 (Multiple sclerosis, unspecified) and enforce use of specific codes: G35.A (Relapsing-remitting multiple sclerosis), G35.C1 (Active secondary progressive multiple sclerosis), or G35.D (Multiple sclerosis, unspecified). Update encounter forms and templates used by providers to reflect the new specific codes. Audit any standing orders or prior authorizations that reference G35 and correct them. Claims submitted with the old general code G35 may be denied or delayed for Independence Blue Cross Medicare Advantage members. Providers should be notified of this change to ensure accurate diagnosis documentation at the point of care.