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08.00.50ae, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Act
by Oct 29, 2025
Effective date
Oct 29, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.50ae to version 08.00.50af, effective 10/29/2025. Key changes include removal of generic ICD-10 code G35 (Multiple sclerosis) and addition of two new codes: G35.A (Relapsing-remitting multiple sclerosis) and M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis). These diagnosis code changes affect coverage determination for rituximab and related biosimilars.
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What to do
by Oct 29, 2025 · 8 steps
01Billing team must update diagnosis code lookup tables and coverage verification systems to reflect ICD-10 changes.
02Remove G35 (Multiple sclerosis - general) from rituximab coverage criteria.
03Add G35.A (Relapsing-remitting multiple sclerosis) to approved indications.
04Add M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis) to approved indications.
05Update claim scrubbing logic and prior authorization workflows in billing software to enforce the new diagnosis codes for HCPCS codes J9311, J9312, Q5115, Q5119, and Q5123.
06Inform clinical staff and providers that general MS diagnosis codes will no longer support rituximab coverage—only specific subtypes.
07Test system changes before the effective date.
08Claims submitted after 10/29/2025 with old diagnosis codes may be denied.
Codes mentioned
J9311J9312Q5115Q5119Q5123G35.AM05.A
Original notice
08.00.50ae, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.022s, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MediumEffective Oct 1, 2025 · PharmacyMA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MediumEffective Jan 1, 2026 · Pharmacy08.00.50af, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MediumEffective Jan 1, 2026 · PharmacyMA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)HighEffective Jan 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list