Linvoseltamab-gcpt (Lynozyfic) (CPB 1089, reviewed 2026-10-14)

Billing team must implement the following precertification and coding workflow for linvoseltamab-gcpt (Lynozyfic): (1) Require precertification of all linvoseltamab-gcpt claims for Aetna commercial plan members via phone (866) 752-7021 or fax (888) 267-3277 before authorization, using Statement of Medical Necessity (SMN) forms available from Specialty Pharmacy Precertification; (2) Validate claims against Criteria for Initial Approval: multiple myeloma patients must have received at least four prior therapies including proteasome inhibitor, immunomodulatory agent, and anti-CD38 monoclonal antibody, OR diagnosis of POEMS syndrome, plasma cell-related MIDD, or plasma cell-related MGRS as single-agent treatment; (3) Ensure diagnostic codes match covered indications (C90.00, C90.02, D47.2, D47.Z9); (4) Use HCPCS code J9601 for linvoseltamab-gcpt and CPT codes 96413-96415 for chemotherapy administration; (5) Verify continuation of therapy reauthorization requires evidence of response without unacceptable toxicity or disease progression; (6) Flag and deny claims lacking precertification or failing to meet clinical criteria, as non-precertified claims will not be paid. This policy applies to all Aetna participating providers and members in applicable plan designs.