Summary
Independence Blue Cross reissued policy 08.01.76d with a diagnostic code refinement: the broad code E78.01 (Familial hypercholesterolemia) has been replaced with the more specific code E78.010 (Homozygous familial hypercholesterolemia [HoFH]) effective 10/01/2025. Coverage criteria, dosing, and clinical requirements for Evkeeza (evinacumab-dgnb) remain unchanged. Billing teams must update claim submission and prior authorization systems to use the new ICD-10 code.
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What to do
Action · 5 steps
01By 10/01/2025: Billing team must update all billing system databases, prior authorization workflows, and claim submission rules to replace ICD-10 code E78.01 with E78.010 for all Evkeeza (J1305) claims.
02Update encounter forms and EMR templates used by providers ordering this medication.
03Remove E78.01 from any active authorizations or standing orders; reissue new authorizations using E78.010.
04Communicate change to clinical staff and prior authorization personnel.
05Claims submitted with the old code (E78.01) after the effective date will be denied or delayed pending correction.
Codes mentioned
J1305E78.010
Original notice
08.01.76d, Evinacumab-dgnb (Evkeeza®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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