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Independence Blue CrossCommercial · Billing Codes · Pharmacy · Rheumatology, Internal Medicine, Oncology +1 moreMedium impact

08.01.15h, Golimumab (Simponi Aria®) Intravenous (IV) Injection

Act
by Sep 30, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated policy 08.01.15h for Golimumab (Simponi Aria IV) effective 10/01/2025, adding new ICD-10 code M05.A for abnormal rheumatoid factor/anti-citrullinated protein antibody with rheumatoid arthritis, and removing numerous M05 and M06 codes (except M06.4) due to unspecified laterality. Billing teams must update diagnosis code validation rules to reflect these changes and ensure prior authorization aligns with the updated covered indications.

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What to do

by Sep 30, 2025 · 5 steps
01Billing team must update diagnosis code validation in billing software to ADD code M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis) as a covered diagnosis for golimumab (Simponi Aria IV, HCPCS J1602) claims.
02Remove all deleted M05 codes (M05.019, M05.029, M05.039, etc.) and all deleted M06 codes (except M06.4) from the allowed diagnosis list for this medication.
03Update prior authorization templates and clinical criteria documentation to reflect these diagnosis code changes.
04Providers should be notified to use M05.A instead of deleted laterality-specific codes when documenting rheumatoid arthritis with rheumatoid factor.
05Claims submitted on or after 10/01/2025 using deleted diagnosis codes will be denied for medical necessity.

Codes mentioned

J1602M05.AM06.4

Original notice

08.01.15h, Golimumab (Simponi Aria®) Intravenous (IV) Injection
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

See all Independence Blue Cross changes →
MA08.070g, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · PharmacyMA08.070f, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · Pharmacy08.01.15g, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · PharmacyMA08.070h, Golimumab and Related Biosimilars for Intravenous InfusionMediumEffective Oct 19, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesRheumatologyInternal MedicineOncologyPharmacyCode J1602Code M05.ACode M06.4

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