CommercialCoverageMedium impact
08.02.33, Guselkumab (Tremfya®) Injection for Intravenous Use
Independence Blue Cross·Dermatology, Rheumatology, Gastroenterology·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
This is a new policy for Guselkumab (Tremfya®) Injection for Intravenous Use effective March 24, 2025. The billing team must review the full policy text to understand coverage criteria, prior authorization requirements, applicable HCPCS codes, and any documentation requirements for this biologic medication.
Action Required
By March 24, 2025: Billing team must obtain and review the complete policy text at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=03&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-02-33 to identify: (1) HCPCS code for Guselkumab injection, (2) prior authorization requirements and process, (3) medical necessity criteria, and (4) any documentation requirements. Update billing software, provider encounter forms, and staff workflows accordingly. Ensure all claims for Guselkumab are submitted with required prior authorization to avoid denials. Contact the payer if specific billing codes or requirements are unclear.