CommercialDocumentationMedium impact
08.02.00c, Mosunetuzumab-axgb (Lunsumio™)
Independence Blue Cross·Pharmacy, Oncology·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.02.00c updates medical necessity criteria and medical coding guidelines for Mosunetuzumab-axgb (Lunsumio™), a specialty pharmaceutical agent. The billing team must implement new medical necessity documentation requirements and coding standards effective immediately to ensure claim compliance and avoid denials.
Action Required
By June 16, 2025: Billing team and clinical staff must (1) access the full policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=06&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-02-00c to identify specific medical necessity criteria and required documentation; (2) update clinical encounter templates and prior authorization forms to capture required medical necessity elements; (3) communicate new criteria to providers and pharmacists; (4) configure billing system edits to flag Lunsumio™ claims lacking required documentation. Without proper documentation of medical necessity and correct coding, claims will be denied or delayed.