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08.00.85r, Tocilizumab and Related Biosimilars for Intravenous Infusion
Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated policy 08.00.85r to 08.00.85u, adding three new HCPCS codes (M0237, M0238, Q0237) for tocilizumab-anoh (Avtozma) COVID-19 treatment effective retroactively to 01/24/2025, and replacing unclassified drug codes (C9399, J3590) with Q5156 for the biosimilar. The policy designates tocilizumab-aazg (Tyenne) as the preferred product, with tocilizumab-anoh as an additional preferred alternative, requiring documentation of contraindication, intolerance, or inadequate response to use nonpreferred products.
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What to do
by Oct 1, 2025 · 5 steps
01Billing team must update billing system and revenue cycle software to recognize and process HCPCS codes M0237, M0238, and Q0237 for tocilizumab-anoh COVID-19 claims, effective retroactively to January 24, 2025.
02Remove use of legacy unclassified codes C9399 and J3590 and replace with Q5156 for tocilizumab-anoh claims.
03Update prior authorization workflows to enforce preferred product requirement (tocilizumab-aazg or tocilizumab-anoh); require provider documentation of contraindication, intolerance, or inadequate response for claims using nonpreferred tocilizumab products (Actemra, Tofidence, other biosimilars).
04Train billing and clinical staff on the new code assignments.
05Retroactive claims from January 24, 2025 forward must be reprocessed or corrected using the new codes.
If missed: Failure to implement will result in claim denials and payment delays.
Codes mentioned
M0237M0238Q0237Q5156C9399J3590J3262M0231M0232
Original notice
08.00.85r, Tocilizumab and Related Biosimilars for Intravenous Infusion
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.045n, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Jan 24, 2025 · Pharmacy08.00.85u, Tocilizumab and Related Biosimilars for Intravenous InfusionHighEffective Sep 14, 2026 · PharmacyMA08.045q, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Jul 1, 2026 · Pharmacy08.00.85t, Tocilizumab and Related Biosimilars for Intravenous InfusionMediumEffective Jul 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list