CommercialCoverageMedium impact
08.00.82o, Ustekinumab for Intravenous Infusion and Subcutaneous Injection
Independence Blue Cross·Gastroenterology, Dermatology, Rheumatology +1 more·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.82o updates coverage, reimbursement, medical necessity criteria, coding guidelines, and general information for Ustekinumab administered via intravenous infusion and subcutaneous injection. This is a recent comprehensive policy update effective July 1, 2025 that may affect multiple aspects of billing and claims processing for this biologic immunosuppressant.
Action Required
By July 1, 2025: Billing and clinical teams must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=07&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-00-82o to identify specific billing codes, prior authorization requirements, medical necessity documentation criteria, and reimbursement rates affected. Update billing system rules, encounter forms, and provider documentation templates accordingly. Identify which administration route (IV infusion vs. subcutaneous injection) requires different coding or authorization. Communicate requirements to all providers and billing staff. Failure to comply with updated medical necessity criteria or coding requirements will result in claim denials.