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Independence Blue CrossCommercial · Billing Codes · Pharmacy · PA · Allergy & Immunology, Pulmonology, Dermatology +1 moreMedium impact

08.00.55m, Omalizumab (Xolair®)

Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated ICD-10 diagnosis codes for Omalizumab (Xolair) coverage effective 10/01/2025. Removed two non-specific allergy codes (Z91.011, Z91.012) and added six more granular codes that distinguish between unspecified allergies and those with tolerance/reactivity to baked milk and eggs. Billing teams must update claim submission systems and encounter forms to use the new specific ICD-10 codes to avoid claim denials.

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What to do

Action · 6 steps
01By 10/01/2025: Billing team must update billing software and claim submission systems to discontinue use of ICD-10 codes Z91.011 (Allergy to milk products) and Z91.012 (Allergy to eggs).
02Replace with the corresponding new codes: Z91.0110, Z91.0111, Z91.0112 for milk allergies; Z91.0120, Z91.0121, Z91.0122 for egg allergies.
03Update provider encounter forms and templates to reflect the new diagnosis code options.
04Coordinate with clinical staff to ensure documentation specifies whether patients have tolerance or reactivity to baked milk/eggs.
05Claims submitted with old codes after 10/01/2025 will be denied or rejected by Independence Blue Cross.
06Verify all claims for Omalizumab (J2357, Q5154) use the appropriate new ICD-10 codes.

Codes mentioned

J2357Q5154Z91.011Z91.012Z91.0110Z91.0111Z91.0112Z91.0120Z91.0121Z91.0122

Original notice

08.00.55m, Omalizumab (Xolair®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

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Related policy hubs

Independence Blue Cross policiesPA policy changesAllergy & ImmunologyPulmonologyDermatologyPharmacyCode J2357Code Q5154Code Z91.011Code Z91.012Code Z91.0110Code Z91.0111Code Z91.0112Code Z91.0120Code Z91.0121Code Z91.0122

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