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Independence Blue CrossCommercial · Coverage · Pharmacy · Rheumatology, Internal Medicine, PharmacyMedium impact

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

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

Summary

Independence Blue Cross added ICD-10 diagnosis code M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis) to policy 08.01.15h for Golimumab (Simponi Aria) IV injection coverage. This expands the diagnostic criteria for coverage eligibility under the existing medical necessity framework, effective October 1, 2025.

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What to do

by Sep 30, 2025 · 4 steps
01Billing team must update diagnosis code validation logic in billing software to recognize M05.A as a covered diagnosis code for Golimumab (Simponi Aria) IV injection (HCPCS J1602) claims on Independence Blue Cross commercial plans.
02Verify that claim submission templates and prior authorization forms include M05.A in the list of acceptable ICD-10 codes for this drug.
03Test claims with M05.A diagnosis code in staging environment before October 1, 2025 effective date.
04Communicate updated coverage to providers and document in policy reference materials.
If missed: Failure to update systems may result in claim denials for qualifying patients with this diagnosis.

Codes mentioned

J1602M05.A

Original notice

08.01.15g, Golimumab (Simponi Aria®) Intravenous (IV) Injection
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.070f, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · PharmacyMA08.070g, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · Pharmacy08.01.15h, 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 MedicinePharmacyCode J1602Code M05.A

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