CommercialDocumentationLow impact
08.01.94d, Nivolumab and Relatlimab-rmbw (Opdualag™) for intravenous use
Independence Blue Cross·PA · Oncology, Dermatology, Pharmacy·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued policy 08.01.94d for Opdualag (nivolumab and relatlimab-rmbw) with no substantive changes to coverage criteria. The policy was updated to align with NCCN Melanoma guidelines (V2.2025) and ICD-10 diagnosis codes were removed from the policy document, requiring billing teams to report the most appropriate diagnosis code based on the medical necessity criteria listed.
Action Required
By June 16, 2025: Billing team should verify that claims for Opdualag (HCPCS J9298) continue to include appropriate ICD-10 diagnosis codes from the policy's medically necessary criteria (unresectable or metastatic melanoma diagnoses, or resectable melanoma with neoadjuvant indications). Since ICD-10 codes were removed from the policy document itself, ensure your billing software and templates reference the appropriate diagnosis codes based on the treatment scenario (first-line, second-line, neoadjuvant, or re-induction therapy). No workflow changes are required, as coverage criteria remain unchanged; this is a documentation clarification only.