Medicare AdvantageBilling CodesMedium impact
MA08.130k, Filgrastim (Neupogen®) and Related Biosimilars, and Tbo-filgrastim (Granix®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross Medicare Advantage added HCPCS code Q5172 (filgrastim-laha/Filkri biosimilar) and removed unclassified drug codes C9399 and J3590, effective 10/01/2026. This update clarifies billing for the newest filgrastim biosimilar and designates it as a non-preferred product requiring documentation of contraindication, intolerance, or inadequate response to preferred alternatives before coverage.
Action Required
By October 1, 2026: Billing team must (1) Update billing system to recognize and accept HCPCS code Q5172 for filgrastim-laha (Filkri) claims submitted to Independence Blue Cross Medicare Advantage; (2) Remove or deactivate codes C9399 and J3590 from filgrastim billing workflows to prevent claim denials; (3) Configure system to flag Q5172 claims as non-preferred and require supporting documentation of member contraindication/intolerance to preferred products (filgrastim-sndz Q5101 or filgrastim-aafi Q5110) or inadequate response; (4) Train clinical staff and providers that Q5172 requires prior documentation before submission—claims lacking this documentation will be denied. Providers should document the clinical reason for non-preferred product selection in the patient record at time of treatment.