Summary
Independence Blue Cross updated policy 08.00.55l to 08.00.55n, expanding Omalizumab (Xolair) coverage to include IgE-mediated food allergy as a new medically necessary indication effective 01/06/2025. The policy also revised frequency criteria for Prevention of Anaphylaxis and added nine new food allergy ICD-10 diagnosis codes (Z91.010-Z91.018, Z91.02).
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What to do
Action · 4 steps
01By 01/06/2025: Billing team must update claim submission systems to recognize the nine new ICD-10 food allergy diagnosis codes (Z91.010, Z91.011, Z91.012, Z91.013, Z91.014, Z91.018, Z91.02) as covered diagnoses supporting medical necessity for Omalizumab (J2357, Q5154).
02Clinical teams must begin documenting IgE-mediated food allergy as a qualifying indication for Omalizumab coverage.
03Update prior authorization templates and medical necessity documentation requirements to reflect the new food allergy indication and revised anaphylaxis prevention frequency criteria.
04Verify that billing software correctly maps food allergy diagnoses to HCPCS codes J2357 and Q5154 to prevent claim denials.
Codes mentioned
J2357Q5154Z91.010Z91.011Z91.012Z91.013Z91.014Z91.018Z91.02
Original notice
08.00.55l, Omalizumab (Xolair®)
medpolicy.ibx.com · Always check the source before changing claims.
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