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Independence Blue CrossCommercial · Billing Codes · Pharmacy · Ophthalmology, Endocrinology, PharmacyLow impact

08.00.41c, Teprotumumab-trbw (Tepezza®)

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross added three new ICD-10 diagnosis codes (H05.831, H05.832, H05.833) for thyroid orbitopathy to policy 08.00.41c effective 10/01/2025. This is a coding update only; the coverage criteria, dosing, and medical necessity requirements for Tepezza remain unchanged. Billing teams must ensure these new codes are available in their systems and used appropriately when submitting claims for thyroid eye disease.

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What to do

by Oct 1, 2025 · 4 steps
01Billing team must verify that ICD-10 codes H05.831 (thyroid orbitopathy, right orbit), H05.832 (thyroid orbitopathy, left orbit), and H05.833 (thyroid orbitopathy, bilateral) are available in the billing system and EMR.
02Update diagnosis code lookup tables and provider resources to include these new codes.
03When providers submit Tepezza (HCPCS J3241) claims for thyroid eye disease, ensure these new H05.83x codes are used in place of or in addition to the existing E05.xx Graves' disease codes, as clinically appropriate.
04No coverage criteria or prior authorization requirements have changed; this is a coding-only update to align with clinical documentation of thyroid orbitopathy.

Codes mentioned

J3241H05.831H05.832H05.833E05.00E05.10E05.20E05.30E05.80E05.90

Original notice

08.00.41c, Teprotumumab-trbw (Tepezza®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

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MA08.115b, Teprotumumab (Tepezza®)MediumEffective Jan 6, 2025 · PharmacyMA08.115b, Teprotumumab (Tepezza®)MediumEffective Jan 6, 2025 · Pharmacy08.00.41b, Teprotumumab-trbw (Tepezza®)MediumEffective Jan 6, 2025 · Pharmacy08.00.41b, Teprotumumab-trbw (Tepezza®)MediumEffective Jan 6, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOphthalmologyEndocrinologyPharmacyCode J3241Code H05.831Code H05.832Code H05.833Code E05.00Code E05.10Code E05.20Code E05.30Code E05.80Code E05.90

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