Medicare AdvantageAdministrativeMedium impact
MA08.047n, Pemetrexed (Pemfexy™)
Independence Blue Cross·Oncology, Pulmonology, Pharmacy·Pharmacy
Effective date
Jun 15, 2026
We identified it
Jun 19, 2026
Summary
Policy MA08.047n has been updated with changes to medical necessity criteria and medical coding guidelines for Pemetrexed (Pemfexy™). The billing team must review the full policy text to identify specific criteria changes and billing code impacts that affect claim submissions for this chemotherapy agent.
Action Required
By June 15, 2026: Billing team must obtain and review the complete MA08.047n policy text from the provided URL to identify: (1) specific medical necessity criteria that must be documented for Pemetrexed claims, (2) any HCPCS codes affected (likely J-codes for drug administration), and (3) updated coding requirements. Update prior authorization processes, billing system rules, and provider documentation templates accordingly. Oncology and pulmonology providers must be notified of new documentation requirements. Claims submitted without proper medical necessity documentation will be denied.