CommercialBilling CodesLow impact
08.00.64i, Natalizumab (Tysabri®) and Related Biosimilars
Independence Blue Cross·PA · Neurology, Gastroenterology, Internal Medicine +1 more·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 08.00.64i for natalizumab (Tysabri) and biosimilar natalizumab-sztn (Tyruko) with updated ICD-10 diagnosis codes. Three MS-related codes were added (G35.A, G35.C1, G35.D) and one generic code (G35) was removed. Medical necessity criteria remain substantively unchanged. The policy covers MS relapsing forms and Crohn's disease with existing approval requirements.
Action Required
By October 1, 2025: Billing team must update coding systems to reflect ICD-10 diagnosis code changes. Remove generic code G35 from claim submission and replace with specific diagnosis codes: G35.A (relapsing-remitting MS), G35.C1 (active secondary progressive MS), or G35.D (unspecified MS) based on clinical documentation. Update billing software and encounter templates to reflect the new code set. Ensure providers document the specific MS subtype to support appropriate coding. No changes to HCPCS codes (J2323, Q5134) or CPT antibody testing codes (83516, 83518, 86711) are required, but verify systems recognize these codes with updated ICD-10 mappings. Verify Crohn's disease coding (K50.xxx series) remains unchanged. No prior authorization or coverage criteria changes have been made.