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08.02.38, Zenocutuzumab-zbco (Bizengri®)
Effective date
Jul 28, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross published a new policy (08.02.38a, effective 07/28/2025) establishing coverage criteria for zenocutuzumab-zbco (Bizengri®) for NRG1 gene fusion-positive non-small cell lung cancer and pancreatic adenocarcinoma. The policy requires specific clinical criteria including prior systemic therapy progression, LVEF ≥50%, and ECOG performance status documentation. All other uses are considered experimental/investigational and not covered.
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What to do
Action · 9 steps
01By 07/28/2025: Billing and clinical teams must implement the following.
02Update billing system to recognize HCPCS code J9382 (zenocutuzumab-zbco) for covered indications only.
03Establish prior authorization workflow requiring documentation of: NRG1 gene fusion positivity, disease progression on/after prior systemic therapy, LVEF ≥50% measured prior to treatment initiation, and applicable ECOG performance status (PS 0-1 or PS 2) per indication.
04For non-small cell lung cancer claims: require evidence of prior systemic therapy failure and LVEF documentation.
05For pancreatic adenocarcinoma claims: require evidence of prior systemic therapy failure, LVEF documentation, and scenario classification (local recurrence post-resection, recurrent metastatic disease, or locally advanced/metastatic disease).
06Deny claims for all other indications as experimental/investigational unless supported by off-label coverage policy 08.01.08 (Pennsylvania members).
07Update encounter templates and prior auth request forms to require ECOG performance status documentation.
08Train providers and billing staff on new coverage criteria.
09Pennsylvania members should also reference policy 08.01.08.
If missed: Failure to obtain proper authorization and documentation will result in claim denials.
Codes mentioned
J9382C25.0C25.1C25.2C25.3C25.7C25.8C25.9C33C34.01C34.02C34.11
Original notice
08.02.38, Zenocutuzumab-zbco (Bizengri®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.183, Zenocutuzumab-zbco (Bizengri®)MediumEffective Jul 28, 2025 · PharmacyMA08.183a, Zenocutuzumab-zbco (Bizengri®)MediumEffective Jun 1, 2026 · Pharmacy08.02.38a, Zenocutuzumab-zbco (Bizengri®)MediumEffective Jun 1, 2026 · PharmacyMA08.185a, Datopotamab deruxtecan (Datroway®)MediumEffective Nov 2, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list