Medicare AdvantageCoverageMedium impact
MA08.168a, Elranatamab-bcmm (Elrexfio®)
Independence Blue Cross·Oncology, Hematology, Pharmacy·Pharmacy
Effective date
May 4, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated policy MA08.168a to expand elranatamab-bcmm (Elrexfio) coverage to include POEMS, MIDD, and MGRS conditions per NCCN Category 2A recommendations, effective 05/04/2026. All ICD-10 diagnosis codes were removed from the policy; billing teams must now report the most appropriate diagnosis code based on medical necessity criteria rather than using a pre-defined list.
Action Required
By 05/04/2026: Billing team must update claims submission procedures for HCPCS code J1323 (elranatamab-bcmm) to reflect expanded coverage indications. Remove reliance on the ICD-10 code list previously included in the policy (C90.00, C90.02, C90.20, C90.22). Train billing and coding staff to select and report the most clinically appropriate ICD-10 diagnosis code based on documented medical necessity for each member—now including POEMS (G89.29 or similar polyneuropathy codes), MIDD, and MGRS (M31.8 or similar monoclonal gammopathy codes) in addition to relapsed/refractory multiple myeloma. Update claim submission guidelines to reference the medical necessity criteria in the updated policy. Ensure prior authorization submissions include sufficient clinical documentation demonstrating the member meets criteria for one of the covered indications. Claims submitted without appropriate diagnosis code support or medical necessity documentation will be denied.