Medicare AdvantageAdministrativeLow impact
08.00.69d, Agalsidase beta (Fabrazyme®) and pegunigalsidase alfa-iwxj (Elfabrio)
Independence Blue Cross·Genetics, Endocrinology, Nephrology +3 more·Pharmacy
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued Policy 08.00.69d with no substantive changes to coverage criteria for agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) in the treatment of Fabry disease. This is a routine annual review reissuance with the policy remaining unchanged since the September 2024 version.
Action Required
No immediate action required. This is a reissuance with no changes from the prior 09/09/2024 version. Billing team should maintain current billing practices using HCPCS codes J0180 (agalsidase beta) and J2508 (pegunigalsidase alfa-iwxj) with ICD-10 diagnosis code E75.21 for Fabry disease. Continue to verify medical necessity criteria and dosing requirements (1 mg/kg IV every 2 weeks) are met before claim submission. No updates to systems, forms, or workflows are necessary.