← Back to list
08.02.00c, Mosunetuzumab-axgb (Lunsumio™)
Act
by Jun 16, 2025
Effective date
Jun 16, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross expanded coverage for mosunetuzumab-axgb (Lunsumio) effective June 16, 2025, adding four new indications: Diffuse Large B-Cell Lymphoma, High-Grade B-Cell Lymphomas, HIV-Related B-Cell Lymphomas, and Post-Transplant Lymphoproliferative Disorders. Criteria for Classic Follicular Lymphoma were revised. ICD-10 diagnosis codes were removed from the policy; billing teams must report the most appropriate diagnosis code supporting medical necessity.
Get alerts when payers change rules like this one
We check Independence Blue Cross and other payers every day and email you when a change matches your specialty and state.
Get Independence Blue Cross alertsPolicy Monitoring is free. No card required.
What to do
by Jun 16, 2025 · 6 steps
01Billing and clinical teams must.
02Update prior authorization workflows in billing system to recognize four new approved indications for HCPCS J9350 (mosunetuzumab-axgb): Diffuse Large B-Cell Lymphoma, High-Grade B-Cell Lymphomas, HIV-Related B-Cell Lymphomas, and Post-Transplant Lymphoproliferative Disorders.
03Implement coverage criteria checks including disease stage, prior therapy requirements, and maximum 8-cycle limit (or 17 cycles if partial response/stable disease).
04Remove any hard-coded ICD-10 diagnosis codes from automated systems since all codes were removed from policy; instead, train billing staff to verify that submitted diagnosis codes match one of the four covered indications and support documented medical necessity.
05Update claim submission templates and encounter forms to prompt providers to document specific disease state and prior therapy lines.
06Ensure prior authorization requests include documented evidence of relapsed/refractory disease, CAR T-cell therapy ineligibility where applicable, and adherence to NCCN-preferred regimen requirements.
If missed: Failure to implement these changes may result in claim denials for non-compliant submissions or requests lacking required clinical documentation.
Codes mentioned
J9350
Original notice
08.02.00c, Mosunetuzumab-axgb (Lunsumio™)
medpolicy.ibx.com · Always check the source before changing claims.