Summary
Independence Blue Cross reissued Policy 08.02.17 on pozelimab-bbfg (Veopoz®) with no substantive changes to coverage criteria. The policy confirms ongoing coverage for CD55-deficient protein-losing enteropathy (CHAPLE disease) in patients age 1+ when specific clinical and laboratory criteria are met, including biallelic CD55 mutation confirmation, documented symptoms, meningococcal vaccination, specialist oversight, and no concurrent complement inhibitor use.
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What to do
Action · 5 steps
01No immediate action required.
02This is a reissue with no changes to the existing policy effective 04/01/2024.
03Billing team should verify that current claims submission processes for J9376 (pozelimab-bbfg) align with documented medical necessity criteria: confirmed CD55 biallelic mutation, presence of qualifying symptoms within 6 months, completed meningococcal vaccination (or documented medical exception), specialist provider ordering, no concurrent complement inhibitors, and no unresolved Neisseria meningitidis infection.
04Ensure prior authorization workflows capture all required clinical documentation before claim submission.
05No system updates or form changes are needed at this time.
Codes mentioned
J9376D84.1K90.49
Original notice
08.02.17, Pozelimab-bbfg (Veopoz®)
medpolicy.ibx.com · Always check the source before changing claims.
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