CommercialCoverageMedium impact
08.00.82o, Ustekinumab for Intravenous Infusion and Subcutaneous Injection
Independence Blue Cross·Rheumatology, Gastroenterology, Dermatology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross has updated its policy for Ustekinumab (Stelara) for both intravenous infusion and subcutaneous injection, affecting coverage criteria, medical necessity requirements, and medical coding guidelines. This comprehensive update includes changes to reimbursement positions and general policy information.
Action Required
By July 1, 2025: Billing team must review the complete updated policy 08.00.82o at the IBX medical policy portal to identify specific changes to coverage criteria, medical necessity documentation requirements, and any affected billing codes for Ustekinumab services. Update billing workflows, prior authorization processes, and staff training accordingly based on the detailed policy changes.