CommercialCoverageMedium impact
08.01.72b, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo®)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
The medical necessity criteria and billing codes for Phesgo® (Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf) have been updated for commercial plans. This affects coverage requirements and coding guidelines for this cancer medication used primarily in oncology practices.
Action Required
By November 17, 2025: Billing team must review updated medical necessity criteria for Phesgo® and verify correct coding guidelines in billing system. Oncology providers should ensure documentation meets new medical necessity requirements. Update prior authorization processes if required to prevent claim denials.