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Independence Blue CrossCommercial · Billing Codes · Pharmacy · PA · Neurology, Pediatrics, PharmacyMedium impact

08.01.36g, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)

Act
by Apr 1, 2026
Effective date
Apr 1, 2026
Identified
Jun 19, 2026

Summary

Independence Blue Cross added HCPCS code C9309 to policy 08.01.36i (superseding 08.01.36g) effective 04/01/2026 for spinal muscular atrophy therapies. Billing teams must recognize this new code for nusinersen (Spinraza) and onasemnogene abeparvovec-xioi (Zolgensma) coverage under the updated medical necessity criteria. The policy maintains existing coverage requirements for genetic confirmation, prescriber qualifications, and motor function assessment metrics.

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What to do

by Apr 1, 2026 · 4 steps
01Billing team must update billing system and encounter forms to recognize and process HCPCS code C9309 for spinal muscular atrophy therapy claims.
02Ensure claims for nusinersen (Spinraza) and onasemnogene abeparvovec-xioi (Zolgensma) include proper genetic documentation (homozygous deletion, homozygous conversion mutation, or compound heterozygote confirmation) and prescriber credentials (neurologist or physiatrist with neuromuscular medicine certification).
03For continuation therapy, require documentation of motor function improvement/stability using standardized scales (HINE, CHOP-INTEND, or HFMSE).
04Claims submitted without updated coding or proper medical necessity documentation will be denied.

Codes mentioned

C9309J2326J3399J3405

Original notice

08.01.36g, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.01.36h, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)MediumEffective Jul 1, 2026 · Pharmacy08.01.36i, Therapies for Spinal Muscular AtrophyHighEffective Sep 14, 2026 · Medical Policy08.01.36e, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)HighEffective Jul 1, 2020 · Pharmacy08.01.36f, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)MediumEffective Mar 23, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPA policy changesNeurologyPediatricsPharmacyCode C9309Code J2326Code J3399Code J3405

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