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08.00.55m, Omalizumab (Xolair®)
Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.55m to 08.00.55n, replacing six general ICD-10 allergy codes with twelve more specific codes that distinguish between unspecified allergies and those with tolerance/reactivity to baked milk and eggs. This affects diagnosis code reporting for omalizumab claims but does not change coverage criteria, billing codes, or reimbursement rates.
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What to do
by Oct 1, 2025 · 4 steps
01Billing and clinical teams must update diagnosis code selection processes to use the new granular ICD-10 codes (Z91.0110, Z91.0111, Z91.0112, Z91.0120, Z91.0121, Z91.0122) instead of the deprecated codes (Z91.011, Z91.012) when submitting omalizumab claims.
02Update EMR templates and billing system drop-down lists to reflect these codes.
03Claims submitted on or after 10/01/2025 with the old codes may be rejected or require rework.
04Ensure providers document the specific type of milk or egg allergy (unspecified vs. tolerance to baked vs. reactivity to baked) to support correct code selection.
Codes mentioned
Z91.0110Z91.0111Z91.0112Z91.0120Z91.0121Z91.0122J2357Q5154
Original notice
08.00.55m, Omalizumab (Xolair®)
medpolicy.ibx.com · Always check the source before changing claims.
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