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08.00.66w, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.66w to 08.00.66x, expanding bevacizumab coverage indications to include vaginal cancer and pediatric CNS cancers, revising criteria for 10 existing indications per FDA/NCCN guidelines, removing dosing/frequency requirements, and adding 19 new ICD-10 diagnosis codes. The policy maintains preferred biosimilar products (Mvasi, Zirabev) with coverage of non-preferred products only for patients with prior exposure to those agents.
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What to do
by Jan 1, 2025 · 6 steps
01Billing team must update diagnosis code validation rules in billing system to recognize and accept the 19 newly added ICD-10 codes for bevacizumab claims (C45.2, C45.7, C45.9, C52, C57.9, C72.1, C83.59, C83.79, C84.49, D42.0, D42.1, D42.9, D43.0, D43.1, D43.4, D43.9, G93.6, I67.89, I67.9, Q85.02, Q85.03, Q85.83).
02Update prior authorization templates to reflect expanded indications: vaginal cancer and pediatric CNS cancers should now be included in covered indication lists.
03Remove any hard-coded dosing or frequency validation rules from billing system, as these requirements have been eliminated from the policy.
04Provider education: inform prescribers that non-preferred bevacizumab products (Avastin and other biosimilars) are now covered only if the patient has previously received a non-preferred product; initial therapy should use preferred biosimilars (Q5118 Zirabev or Q5126 Alymsys) to avoid claim denials.
05Update encounter forms and prior auth request forms to remove any dosing frequency fields.
06Failure to update diagnosis code lists will result in claim denials for newly eligible indications.
If missed: Failure to clarify preferred vs. non-preferred product requirements may result in patient costs and claim rejections.
Codes mentioned
C9257J9035Q5107Q5118Q5126Q5129Q5160C45.2C45.7C45.9C52C57.9C72.1C83.59C83.79C84.49D42.0D42.1D42.9D43.0D43.1D43.4D43.9G93.6I67.89I67.9Q85.02Q85.03Q85.83
Original notice
08.00.66w, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic Use
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.072o, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseHighEffective Jan 1, 2025 · PharmacyMA08.072p, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseMediumEffective Mar 23, 2026 · Pharmacy08.00.66x, Bevacizumab (Avastin®) and Related Biosimilars For Oncologic UseMediumEffective Mar 23, 2026 · PharmacyMA08.073u, Intravitreal Injection of Vascular Endothelial Growth Factor (VEGF) Antagonists, VEGF Biosimilars, and Combination VEGF/Angiopoietin-2 (Ang-2) InhibitorsMediumEffective Jan 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list
Related policy hubs
Independence Blue Cross policiesPA policy changesOncologyHematologyPharmacyRadiation OncologyPalliative CareCode C9257Code J9035Code Q5107Code Q5118Code Q5126Code Q5129Code Q5160Code C45.2Code C45.7Code C45.9Code C52Code C57.9Code C72.1Code C83.59Code C83.79Code C84.49Code D42.0Code D42.1Code D42.9Code D43.0Code D43.1Code D43.4Code D43.9Code G93.6Code I67.89Code I67.9Code Q85.02Code Q85.03Code Q85.83