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CommercialDocumentationMedium impact

08.01.72b, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)

Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Days to comply
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Summary

Policy 08.01.72b updates medical necessity criteria and medical coding requirements for Phesgo® (Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf), a combination biologic therapy used in oncology. The billing team must review updated documentation requirements and coding guidelines to ensure compliant claim submission for this specialty pharmaceutical.

Action Required

Action needed
By 2025-11-17: Billing team and providers must review Policy 08.01.72b for updated medical necessity criteria and medical coding requirements for Phesgo® claims. Update clinical documentation templates and billing software to reflect new criteria. Coordinate with oncology providers to ensure all Phesgo® prescriptions include required medical necessity documentation. Claims submitted without compliance to new criteria will be subject to denial. Reference the full policy at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=11&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-01-72b for complete coding and documentation requirements.

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