CommercialBilling CodesHigh impact
08.00.78av, Self-Administered Drugs and Biologics
Independence Blue Cross·Hematology, Pharmacy·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.78av to 08.00.78ay, replacing three self-administered drug/biologic HCPCS codes with specific product-based codes effective 10/01/2025: fosdenopterin (J3590→J1809), concizumab-mtci (J3590→J7173), and fitusiran (J3590→J7174). Billing teams must update systems to use the new specific codes instead of the generic J3590 code to ensure proper claim processing under the pharmacy benefit.
Action Required
By September 30, 2025: Billing team must update billing software and EMR systems to replace J3590 (Unclassified biologics) with the three new specific HCPCS codes: J1809 for fosdenopterin (Nulibry), J7173 for concizumab-mtci (Alhemo), and J7174 for fitusiran (Qfitlia). Update all encounter templates, charge masters, and superbill mappings. Providers must verify member benefits for these drugs under the pharmacy benefit rather than medical benefit. Do not bill S9370 injection therapy administration codes when reporting these self-administered drugs. Claims submitted with the old J3590 code after 10/01/2025 will be denied; ensure coding tables are current in all billing systems before the effective date.