CommercialCoverageMedium impact
08.00.41b, Teprotumumab-trbw (Tepezza®)
Independence Blue Cross·Ophthalmology, Rheumatology, Endocrinology +1 more·Pharmacy
Effective date
Jan 6, 2025
We identified it
Jun 19, 2026
Summary
Policy 08.00.41b establishes coverage and medical necessity criteria for Teprotumumab-trbw (Tepezza®), a biologic drug for thyroid eye disease. This recent policy (effective 01/06/2025) includes updates to coverage position, medical necessity requirements, billing codes, and general guidelines. Billing teams must review the full policy document to identify specific code requirements and prior authorization mandates.
Action Required
By 01/06/2025: 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=01&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#commercial-08-00-41b to identify: (1) specific HCPCS codes for Tepezza® administration and dosing, (2) medical necessity documentation requirements, (3) prior authorization requirements, and (4) any coding guidelines. Update billing software, encounter templates, and provider documentation checklists accordingly. Identify which clinical staff (likely rheumatology, ophthalmology, or endocrinology) will manage claims for this drug. Without access to the full policy text, specific codes cannot be extracted from this summary—contact the payer directly or access the policy portal to obtain complete coding and authorization details. Failure to comply with medical necessity criteria and coding requirements will result in claim denials.