Glofitamab-gxbm (Columvi) (CPB 1036, reviewed 2026-09-14)

IMMEDIATE: Billing team must implement mandatory precertification workflow for glofitamab-gxbm (Columvi) claims. (1) Update billing system to flag all claims with HCPCS code J9286 as requiring precertification before submission. (2) Establish precertification process requiring contact with Aetna at (866) 752-7021 or fax (888) 267-3277 before treatment initiation. (3) Ensure providers and clinical staff document: approved diagnosis (must match policy-specified lymphoma subtypes), confirmation of obinutuzumab pretreatment 7 days before Columvi, prior treatment history (minimum 2 lines for single-agent use or documented refractory disease for combination therapy), and facility capability to manage cytokine release syndrome. (4) Update encounter forms and EMR templates to capture these required documentation elements. (5) Configure billing system to reject claims exceeding 12 cycles of treatment unless documented medical justification for continuation exists. (6) Train billing and front-desk staff that claims lacking precertification approval or missing required documentation will be denied by Aetna. (7) Verify facility accreditation for CRS management capability before scheduling treatment. Failure to obtain precertification will result in claim denials and potential patient billing issues.