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Independence Blue CrossCommercial · Administrative · Pharmacy · PA · Oncology, Dermatology, PharmacyLow impact

08.02.22, Lifileucel (Amtagvi™)

Effective date
Oct 21, 2024
Identified
Jun 19, 2026

Summary

Independence Blue Cross has reissued policy 08.02.22 on lifileucel (Amtagvi™) with no substantive changes from the original October 2024 policy. This is a confirmation of the existing coverage criteria for this tumor-infiltrating lymphocyte (TIL) therapy in adult patients with unresectable or metastatic melanoma who have failed PD-1 inhibitors and BRAF/MEK inhibitors. Billing teams should continue applying the existing medical necessity requirements and use HCPCS codes C9399 or J3590 for claims.

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What to do

Action · 6 steps
01No immediate action required.
02This is a reissue with no changes to the existing October 21, 2024 policy.
03Billing team should verify that current claim submission processes for lifileucel (Amtagvi™) already include: (1) verification of prior treatment with PD-1 inhibitor and BRAF/MEK inhibitor; (2) ECOG performance status 0 or 1; (3) resectable lesion ≥1.5 cm; (4) adequate renal, pulmonary, and cardiac function; (5) no active systemic infection, uncontrolled brain metastasis, uveal/ocular melanoma, or prior cell transfer therapy.
04Continue using HCPCS codes C9399 or J3590 for billing.
05Ensure prior authorization documentation captures all medical necessity criteria before claim submission.
06Pennsylvania members should reference policy 08.01.08 for Stage 4 advanced metastatic cancer coverage mandates.

Codes mentioned

C9399J3590C43.0C43.111C43.112C43.121C43.122C43.21C43.22C43.30C43.31C43.39

Original notice

08.02.22, Lifileucel (Amtagvi™)
medpolicy.ibx.com · Always check the source before changing claims.
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Related policy hubs

Independence Blue Cross policiesPA policy changesOncologyDermatologyPharmacyCode C9399Code J3590Code C43.0Code C43.111Code C43.112Code C43.121Code C43.122Code C43.21Code C43.22Code C43.30Code C43.31Code C43.39

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