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08.01.75e, Margetuximab-cmkb (Margenza)
Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross has reissued Policy 08.01.75e for Margetuximab-cmkb (Margenza) with updated ICD-10 CM codes effective October 1, 2025. Three new inflammatory breast cancer diagnosis codes (C50.A0, C50.A01, C50.A02) have been added to the policy. Coverage criteria and clinical requirements remain unchanged from the previous version.
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What to do
by Oct 1, 2025 · 4 steps
01Billing and clinical documentation teams should update internal diagnosis code reference lists and billing system configuration to recognize the three new ICD-10 CM codes (C50.A0, C50.A01, C50.A02) for malignant inflammatory neoplasm of breast when supporting claims for Margetuximab-cmkb (J9353).
02Verify that billing software accepts these codes for this drug's coverage criteria.
03No changes to prior authorization processes, coverage criteria, or clinical guidelines are required.
04This is a routine annual policy reissue with diagnostic code maintenance only.
Codes mentioned
J9353C50.A0C50.A01C50.A02
Original notice
08.01.75e, Margetuximab-cmkb (Margenza)
medpolicy.ibx.com · Always check the source before changing claims.
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