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Independence Blue CrossCommercial · Coverage · Pharmacy · PA · Oncology, Endocrinology, PharmacyMedium impact

08.01.40h, Lanreotide (Somatuline® Depot)

Act
by Nov 17, 2025
Effective date
Nov 17, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated policy 08.01.40h to 08.01.40i, expanding coverage criteria for Lanreotide (Somatuline Depot) for neuroendocrine and adrenal tumors to align with NCCN guidelines. All ICD-10 diagnosis codes were removed from the policy text; billing teams must now report the most appropriate diagnosis code supporting medical necessity. Effective November 17, 2025.

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What to do

by Nov 17, 2025 · 5 steps
01Billing team must update claim submission procedures to ensure proper diagnosis coding for Lanreotide claims.
02Since ICD-10 codes are no longer listed in the policy, providers and billing staff must select the most appropriate diagnosis code from the medical record that supports one of the medically necessary conditions (acromegaly, carcinoid syndrome, CNS sellar tumors, or neuroendocrine/adrenal tumors per NCCN criteria).
03Update any internal reference documents, templates, or prior authorization checklists that previously relied on the removed Attachment A ICD-10 code list.
04Verify that claims for J1930 and J1932 include documentation of the specific condition and applicable NCCN criteria met (e.g., unresectable GEP-NETs, disease progression, tumor burden level).
05Claims lacking appropriate diagnosis coding or medical necessity documentation may be denied.

Codes mentioned

J1930J1932

Original notice

08.01.40h, Lanreotide (Somatuline® Depot)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.090i, Lanreotide (Somatuline Depot)MediumEffective Sep 4, 2026 · Medical Policy08.01.40i, Lanreotide (Somatuline Depot)MediumEffective Sep 4, 2026 · Medical PolicyMA08.090h, Lanreotide (Somatuline® Depot)MediumEffective Nov 17, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPA policy changesOncologyEndocrinologyPharmacyCode J1930Code J1932

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