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08.01.67d, Lurbinectedin (Zepzelca®)
Act
by May 31, 2026
Effective date
Jun 1, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.01.67d for Lurbinectedin (Zepzelca®) effective June 1, 2026, removing specific ICD-10 lung cancer diagnosis codes (C33, C34.xx series) and requiring providers to report the most appropriate diagnosis code supporting medical necessity criteria instead. Coverage remains for small cell lung cancer treatment in specific clinical scenarios per FDA and NCCN guidelines.
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What to do
by May 31, 2026 · 6 steps
01Billing team must update coding practices for lurbinectedin (J9223) claims to Independence Blue Cross.
02Remove hard-coded ICD-10 diagnosis codes C33 and C34.00-C34.92 from billing system templates and claim submission rules.
03Implement requirement for providers to select and document the single most appropriate ICD-10 diagnosis code that supports medical necessity per policy criteria (e.g., extensive-stage SCLC with progression on platinum therapy).
04Update claim validation rules to reject claims with multiple lung cancer codes or non-specific codes.
05Train billing staff and providers on which diagnosis codes align with each coverage scenario (maintenance therapy, subsequent systemic therapy, progression/relapse).
06Implement claim auditing process to ensure appropriate diagnosis code selection before submission.
If missed: Failure to report appropriate supporting diagnosis codes will result in claim denials or requests for medical record review.
Codes mentioned
J9223
Original notice
08.01.67d, Lurbinectedin (Zepzelca®)
medpolicy.ibx.com · Always check the source before changing claims.