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08.00.66x, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Act
by Mar 23, 2026
Effective date
Mar 23, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.66x to reflect revised FDA labeling and NCCN compendia for bevacizumab and biosimilars. Medical necessity criteria were updated for 10 cancer indications, 4 ICD-10 codes for uncertain neoplasms were removed, and a new HCPCS code Q5160 (bevacizumab-nwgd/Jobevne) was added to the covered products list.
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What to do
by Mar 23, 2026 · 6 steps
01Billing team must update billing system to recognize new HCPCS code Q5160 (bevacizumab-nwgd/Jobevne) as a covered bevacizumab biosimilar.
02Remove ICD-10 codes D39.11, D39.12, D39.8, and D39.9 from claim validation logic—do not use for ovarian/female genital organ neoplasms of uncertain behavior.
03Ensure all 7 HCPCS bevacizumab codes (C9257, J9035, Q5107, Q5118, Q5126, Q5129, Q5160) validate correctly in billing software.
04Verify that preferred biosimilar products (Q5118 Zirabev and Q5126 Alymsys) are configured to process without step therapy requirements per policy guidelines.
05Oncology providers should be notified of updated medical necessity criteria for the 10 revised cancer indications (CNS tumors, cervical, colon/rectal, hepatobiliary, kidney, mesothelioma, NSCLC, ovarian, small bowel, uterine, and vulvar cancers).
06Update encounter templates and prior authorization forms to reflect current indications.
If missed: Failure to update billing configuration may result in claim processing errors or rejections for Q5160 claims or incorrect denials for removed ICD-10 codes.
Codes mentioned
C9257J9035Q5107Q5118Q5126Q5129Q5160D39.11D39.12D39.8D39.9
Original notice
08.00.66x, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
medpolicy.ibx.com · Always check the source before changing claims.
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