Epcoritamab-bysp (Epkinly) (CPB 1034, reviewed 2026-10-16)

Billing team and providers must implement precertification requirement for epcoritamab-bysp (Epkinly) for all Aetna commercial plan members. Before submitting claims with CPT 96401 or HCPCS J9321 for any B-cell lymphoma diagnosis, obtain precertification by calling (866) 752-7021 or faxing (888) 267-3277. Verify that treatment meets one of the specified approval criteria (combination therapy with lenalidomide/rituximab, combination with GemOx, or single-agent after 2+ prior therapies). For follicular lymphoma patients receiving Epkinly with lenalidomide and rituximab, track cycle count in billing system and enforce the 12-cycle maximum authorization limit. Update encounter forms and billing software to capture the specific treatment indication and drug combination to support medical necessity documentation. Claims submitted without prior authorization or outside approved indications will be denied.