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MA08.183a, Zenocutuzumab-zbco (Bizengri®)
Act
by Jun 1, 2026
Effective date
Jun 1, 2026
Identified
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA08.183a expands coverage for Zenocutuzumab-zbco (Bizengri®) by removing a restrictive exclusion criterion for non-small cell lung cancer and adding 16 new ICD-10 diagnosis codes for pancreatic and lung cancer indications. The policy now covers the drug for NRG1 gene fusion-positive NSCLC and pancreatic adenocarcinoma under specified medical necessity criteria.
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What to do
by Jun 1, 2026 · 6 steps
01Billing team must update claim submission and prior authorization systems to recognize the 16 newly added ICD-10 codes (pancreatic adenocarcinoma C25.0-C25.3, C25.7-C25.9 and lung cancer C33, C34.01-C34.02, C34.11-C34.12, C34.2, C34.31-C34.32, C34.81-C34.82, C34.91-C34.92) for HCPCS code J9382 (Zenocutuzumab-zbco).
02Remove the previously applied NSCLC exclusion criteria from billing logic.
03Ensure prior authorization requests for Bizengri® now verify: (1) NRG1 gene fusion-positive status documented in medical record, (2) disease progression on/after prior systemic therapy, (3) left ventricular ejection fraction (LVEF) ≥50% prior to initiation.
04For pancreatic adenocarcinoma claims, additionally verify one of three scenarios (local recurrence post-resection, recurrent metastatic disease, or locally advanced/metastatic disease) and ECOG performance status (PS 0-1 or PS 2).
05Train prior authorization team on updated medical necessity criteria.
06Claims submitted after June 1, 2026 without proper documentation of these criteria will be denied.
Codes mentioned
J9382C25.0C25.1C25.2C25.3C25.7C25.8C25.9C33C34.01C34.02C34.11C34.12C34.2C34.31C34.32C34.81C34.82C34.91C34.92
Original notice
MA08.183a, Zenocutuzumab-zbco (Bizengri®)
medpolicy.ibx.com · Always check the source before changing claims.
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