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08.01.76d, Evinacumab-dgnb (Evkeeza®)
Act
by Sep 30, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 08.01.76d for Evinacumab-dgnb (Evkeeza) with a diagnostic code change: the non-specific code E78.01 (Familial hypercholesterolemia) has been replaced with the more specific code E78.010 (Homozygous familial hypercholesterolemia [HoFH]). No clinical coverage criteria changed. Billing teams must update claim submission to use the new ICD-10 code effective October 1, 2025.
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What to do
by Sep 30, 2025 · 4 steps
01Billing team must update all billing systems, templates, and claim submission protocols to replace ICD-10 diagnosis code E78.01 with E78.010 for all Evinacumab-dgnb (Evkeeza) claims.
02Remove E78.01 from any pre-populated diagnosis code lists in the EMR or billing software.
03Notify providers to use E78.010 on all orders and encounter documentation.
04Claims submitted on or after October 1, 2025, using the old code E78.01 may be rejected or delayed for code correction, impacting reimbursement timelines.
Codes mentioned
J1305E78.010
Original notice
08.01.76d, Evinacumab-dgnb (Evkeeza®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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