08.01.69d, Atezolizumab (Tecentriq®) and Atezolizumab with Hyaluronidase-tqjs (Tecentriq Hybreza TM)

By January 31, 2025: Billing and clinical staff must obtain and review the full policy text for 08.01.69d to identify specific medical necessity criteria changes for Atezolizumab (Tecentriq®) and Tecentriq Hybreza™. Update prior authorization workflows and claim submission procedures to reflect new criteria. Ensure providers document medical necessity according to updated guidelines before submitting claims. Train billing team on new requirements. Note: Specific HCPCS codes (J9022 or similar biologics codes) should be cross-referenced with updated criteria. Contact the payer or access the full policy at https://medpolicy.ibx.com/ibc/Commercial/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=01&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-01-69d for complete details. Claims submitted without adherence to new medical necessity criteria may be denied.