CommercialBilling CodesMedium impact
08.01.73i, Filgrastim (Neupogen®) and Related Biosimilars, and tbo-filgrastim (Granix®)
Independence Blue Cross·PA · Oncology, Hematology, Pharmacy·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated filgrastim policy (08.01.73i to 08.01.73k) effective 07/01/2025, revising coverage criteria for AML consolidation chemotherapy and lower-risk MDS treatment per NCCN guidelines, updating chemotherapy regimen examples in Attachment A, and deleting HCPCS code C9173 (filgrastim-txid/Nypozi). Billing teams must remove the deleted code from systems and update documentation to reflect new diagnosis code requirements (ICD-10 codes removed from policy text).
Action Required
By June 30, 2025: (1) Billing team must remove HCPCS code C9173 (filgrastim-txid/Nypozi) from all billing software, superbills, and charge capture systems to prevent claim denials. (2) Update prior authorization workflows to reflect new NCCN guidelines for AML consolidation chemotherapy and lower-risk MDS indications. (3) Remove any ICD-10 diagnosis codes that were previously embedded in billing system rules—providers must now manually report appropriate diagnosis codes supporting medical necessity per the policy criteria. (4) Providers should be notified that filgrastim products are listed as preferred (Zarxio, Nivestym) versus nonpreferred (Neupogen, Granix, Releuko, Filkri, Nypozi), and nonpreferred products require documentation of contraindication, intolerance, or inadequate response to preferred products. Claims submitted with C9173 or without supporting diagnosis codes aligned to policy indications will be denied.