← Back to list
08.00.33u, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.33u to version 08.00.33w, adding three new ICD-10 CM diagnosis codes (C50.A0, C50.A01, C50.A02) for malignant inflammatory neoplasm of breast effective 10/01/2025. This affects coverage determination for trastuzumab and related biosimilars in inflammatory breast cancer cases. The policy maintains preferred biosimilar products (Ontruzant, Ogivri, Kanjinti) with non-preferred products requiring documentation of contraindication, intolerance, or inadequate response.
Get alerts when payers change rules like this one
We check Independence Blue Cross and other payers every day and email you when a change matches your specialty and state.
Get Independence Blue Cross alertsPolicy Monitoring is free. No card required.
What to do
by Oct 1, 2025 · 5 steps
01Billing team must update the billing system and encounter forms to recognize the three new ICD-10 CM diagnosis codes (C50.A0, C50.A01, C50.A02) for inflammatory breast cancer.
02Ensure claims processing logic properly applies preferred/non-preferred trastuzumab product rules based on these new codes.
03Update medical coders to correctly assign these codes when reviewing trastuzumab therapy claims for inflammatory breast cancer.
04Verify that claims submitted with these new codes trigger appropriate preferred product routing (J9356, Q5112, Q5114, Q5117) before routing to non-preferred alternatives (J9355, Q5113, Q5116, Q5146).
05Train billing staff on documentation requirements for non-preferred products: contraindication, intolerance, or inadequate response to preferred products must be present.
If missed: Failure to implement these code changes will result in claims being processed under outdated coding logic and potential denials or rerouting.
Codes mentioned
J9355J9356Q5112Q5113Q5114Q5116Q5117Q5146C50.A0C50.A01C50.A02
Original notice
08.00.33u, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.018k, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)LowEffective Oct 1, 2025 · PharmacyMA08.018j, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)MediumEffective Jun 16, 2025 · PharmacyMA08.018l, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)HighEffective Jan 1, 2026 · PharmacyMA08.018m, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)MediumEffective Apr 20, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list