Medicare AdvantageCoverageHigh impact
MA08.083n, Leuprolide (Camcevi™, Camcevi ETM®, Eligard®, Fensolvi®, Lupron Depot®)
Independence Blue Cross·Oncology, Urology, Pharmacy·Pharmacy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross Medicare Advantage added ICD-10 code F64.A (Gender identity disorder, in remission) as NOT medically necessary for leuprolide acetate products (J1950, J9217, J1951, J1952), effective 10/01/2026. This exclusion means claims for leuprolide with this diagnosis code will be denied. The policy also clarifies preferred vs. nonpreferred leuprolide products, with preferred products (Eligard, Lupron Depot 7.5 mg) designated for prostate cancer and salivary gland tumors.
Action Required
By 10/01/2026: Billing team must update claim scrubbing rules in billing software to identify and flag claims containing ICD-10 code F64.A paired with leuprolide HCPCS codes J1950, J9217, J1951, or J1952, as these combinations will be denied as not medically necessary. Notify providers that leuprolide is not covered for gender identity disorder diagnosis codes. Update denial messaging to reflect this exclusion. Medical coders should review existing patient records for any active leuprolide treatment with F64.A diagnosis and coordinate with providers on alternative diagnoses or treatment plans before the effective date to prevent claim denials.