Summary
Independence Blue Cross reissued MA08.172 on 10/28/2026 with no substantive changes to its coverage criteria for lifileucel (Amtagvi) in Medicare Advantage plans. The policy continues to cover this tumor-infiltrating lymphocyte therapy as second-line or subsequent treatment for unresectable or metastatic melanoma in adults meeting specific clinical and performance criteria. Billing teams should verify current applicability and confirm that prior authorization workflows align with the established medical necessity requirements.
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What to do
Action · 4 steps
01Already effective since 10/21/2024: Verify that the practice has implemented coverage criteria for lifileucel (Amtagvi) claims under Independence Blue Cross Medicare Advantage plans and confirm current applicability.
02Ensure billing workflows require prior authorization documentation demonstrating that patients meet all medical necessity criteria, including: second-line or subsequent systemic therapy status, ECOG performance status 0 or 1, resectable lesion ≥1.5 cm post-resection, stable kidney/pulmonary/cardiac function, absence of active systemic infection, no uncontrolled brain metastasis, no uveal/ocular melanoma, and no prior cell transfer therapy history.
03Confirm that claims use HCPCS codes C9399 or J3590 and appropriate melanoma ICD-10 diagnosis codes.
04The reissue on 10/28/2026 contains no coverage changes; no immediate billing system updates are required unless prior authorization processes were not previously implemented.
Codes mentioned
C9399J3590C43.0C43.111C43.112C43.121C43.122C43.21C43.22C43.30C43.31C43.39
Original notice
MA08.172, Lifileucel (Amtagvi™)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →08.02.22, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · PharmacyMA08.172, Lifileucel (Amtagvi™)LowNo effective date · Pharmacy08.02.22, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · PharmacyMA08.070h, Golimumab and Related Biosimilars for Intravenous InfusionMediumEffective Oct 19, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list