Medicare AdvantageCoverageMedium impact
MA08.173b, Tislelizumab-jsgr (Tevimbra®)
Independence Blue Cross·Oncology, Pharmacy, Hematology·Pharmacy
Effective date
Oct 1, 2026
We identified it
Oct 2, 2026
Summary
Independence Blue Cross Medicare Advantage added ICD-10 code C78.32 (Secondary malignant neoplasm of pharynx) to policy MA08.173b for tislelizumab-jsgr (Tevimbra®) coverage effective 10/01/2026. This expands the conditions for which this immunotherapy drug is covered under Medicare Advantage plans.
Action Required
By September 15, 2026: Billing team must update claim submission and authorization systems to recognize ICD-10 code C78.32 as a covered indication for HCPCS J9329 (tislelizumab-jsgr) under Independence Blue Cross Medicare Advantage plans. Update prior authorization workflows to accept secondary malignant neoplasm of pharynx claims. Notify providers treating IBX MA members with secondary pharyngeal cancers that coverage criteria now apply. Review existing denied claims from IBX MA for this diagnosis to determine if resubmission is warranted. Failure to update systems may result in unnecessary claim denials for eligible secondary pharyngeal cancer patients.