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Independence Blue CrossCommercial · Billing Codes · Pharmacy · Neurology, Pediatrics, PharmacyHigh impact

08.01.36e, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)

Act
immediately
Effective date
Jul 1, 2020
Identified
Jun 19, 2026

Summary

This policy bulletin (08.01.36e, superseded by 08.01.36i as of 10/02/2024) covers two gene therapies for spinal muscular atrophy: nusinersen (Spinraza) and onasemnogene abeparvovec-xioi (Zolgensma). Key billing update from 07/01/2020: three unclassified drug/biologic HCPCS codes (C9399, J3490, J3590) were removed and replaced with specific codes J3399 (Zolgensma) and J3405 (Itvisma). Billing teams must use the correct HCPCS code and revenue code 0892 for genetic therapy claims to avoid denials.

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What to do

immediately · 7 steps
01Billing team must update billing software to DISCONTINUE use of terminated HCPCS codes C9399, J3490, and J3590 for SMA therapies.
02For nusinersen (Spinraza) claims, use HCPCS code J2326.
03For onasemnogene abeparvovec-xioi (Zolgensma) claims, use HCPCS code J3399 with revenue code 0892 (Special Processed Drugs - FDA Approved Genetic Therapy) on facility claims.
04For onasemnogene abeparvovec-brve (Itvisma) claims, use HCPCS code J3405.
05Update billing system rules to reject claims using old codes and provide claim scrubbing edits.
06Notify providers and facility billing departments of code requirements.
07NOTE: This policy is currently superseded by version 08.01.36i (effective 10/02/2024) — verify current coverage criteria and any additional updates in the latest version before processing claims.

Codes mentioned

J2326J3399J3405C9399J3490J3590

Original notice

08.01.36e, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.007ax, Medicare Part B vs. Part D Crossover DrugsMediumEffective Aug 30, 2026 · Pharmacy08.01.36i, Therapies for Spinal Muscular AtrophyHighEffective Sep 14, 2026 · Medical PolicyMA08.007av, Medicare Part B vs. Part D Crossover DrugsMediumEffective Jun 15, 2026 · Pharmacy08.01.36h, Therapies for Spinal Muscular Atrophy Nusinersen (Spinraza®) and Onasemnogene abeparvovec-xioi (Zolgensma®)MediumEffective Jul 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesNeurologyPediatricsPharmacyCode J2326Code J3399Code J3405Code C9399Code J3490Code J3590

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