CommercialBilling CodesMedium impact
08.01.26e, Enzyme Replacement Therapy for Adenosine Deaminase Severe Combined Immune Deficiency (e.g., elapegademase-lvlr [Revcovi])
Independence Blue Cross·PA · Pediatrics, Allergy & Immunology, Genetics·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has reissued policy 08.01.26e with no substantive changes to coverage criteria for elapegademase-lvlr (Revcovi) for ADA-SCID treatment. However, HCPCS code J2504 (pegademase bovine) has been deleted effective 01/01/2026 because Adagen is no longer manufactured. Billing teams must stop using J2504 and ensure claims use only the valid unclassified biologic codes (C9399 or J3590).
Action Required
By 01/01/2026: Billing team must remove HCPCS code J2504 (pegademase bovine) from all billing systems, templates, and provider education materials. Update billing software to reject or flag J2504 claims as invalid. Ensure all elapegademase-lvlr (Revcovi) claims use only C9399 or J3590 instead. Notify providers that pegademase bovine (Adagen) is no longer reimbursable under Independence Blue Cross commercial plans due to market withdrawal. Configure system to allow only IBC-approved HCPCS codes for ADA-SCID enzyme replacement therapy. Failure to comply will result in claim denials for J2504 submissions.