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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Oncology, Pulmonology, PharmacyMedium impact

MA08.176a, Tarlatamab-dlle (Imdelltra® for intravenous use

Act
by Jun 15, 2026
Effective date
Jun 15, 2026
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.176a to expand coverage criteria for tarlatamab-dlle (Imdelltra) to include treatment of brain metastases in small cell lung cancer (SCLC), added new ICD-10 diagnosis code C79.31 for secondary brain malignancy, and transitioned billing from temporary codes (C9170, J3590) to permanent HCPCS code J9026. Effective June 15, 2026, billing teams must update systems to use the new code and ensure prior authorization processes align with expanded coverage scenarios.

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What to do

by Jun 15, 2026 · 5 steps
01Billing team must update billing system to delete temporary HCPCS codes C9170 and J3590 and implement permanent code J9026 (Injection, tarlatamab-dlle, 1 mg) for all tarlatamab-dlle claims.
02Update prior authorization workflow to include new covered indication: brain metastases in SCLC (limited or extensive) in addition to existing ES-SCLC indication.
03Add ICD-10 code C79.31 (Secondary malignant neoplasm of brain) to billing system diagnosis code lists and clinical documentation templates.
04Providers and clinical staff must document which treatment scenario applies (initial vs. recurrent brain metastases, limited vs. extensive disease) per policy medical necessity criteria.
05Implement system edits to require ECOG performance status 0-2 documentation for ES-SCLC claims.
If missed: Failure to transition to J9026 will result in claim denials; claims submitted with deleted codes will be rejected.

Codes mentioned

J9026C9170J3590C79.31

Original notice

MA08.176a, Tarlatamab-dlle (Imdelltra® for intravenous use
medpolicy.ibx.com · Always check the source before changing claims.
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Related policy hubs

Independence Blue Cross policiesOncologyPulmonologyPharmacyCode J9026Code C9170Code J3590Code C79.31

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