CommercialCoverageMedium impact
08.02.18a, Elranatamab-bcmm (Elrexfio®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
May 4, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.02.18a to expand elranatamab-bcmm (Elrexfio®) coverage beyond relapsed/refractory multiple myeloma to include POEMS, MIDD, and MGRS based on NCCN recommendations. All ICD-10 diagnosis codes were removed from the policy; billing teams must now report the most appropriate diagnosis code from member records to support medical necessity.
Action Required
By May 4, 2026: Billing team must update system logic and claim submission procedures for HCPCS code J1323 (elranatamab-bcmm). CRITICAL CHANGE: Do NOT use pre-populated ICD-10 diagnosis codes from the policy. Instead, require providers to document and submit the most appropriate diagnosis code from the patient's medical record that supports medical necessity for one of these covered indications: (1) relapsed/refractory multiple myeloma after ≥4 prior therapies including proteasome inhibitor, immunomodulatory agent, and anti-CD38 antibody, OR (2) POEMS, MIDD, or MGRS (when applicable). Update claim submission forms and prior authorization workflows to require explicit diagnosis code entry. Ensure documentation requirements are communicated to all providers submitting elranatamab-bcmm claims. Update denial reason codes in billing system to flag claims lacking appropriate diagnosis documentation. Failure to obtain and submit correct diagnosis codes will result in claim denials.