Medicare AdvantageCoverageMedium impact
MA08.148c, Amivantamab-vmjw (Rybrevant®) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro™)
Independence Blue Cross·Oncology, Pharmacy·Pharmacy
Effective date
Apr 20, 2026
We identified it
Jun 19, 2026
Summary
MA08.148c policy updates medical necessity criteria, medical coding, and general guidelines for Amivantamab-vmjw (Rybjevant®) and Amivantamab and hyaluronidase-lpuj (Rybjevant Faspro™). This is a recent Medicare Advantage policy change effective 04/20/2026 that requires billing teams to review and implement updated coverage criteria and coding requirements for these oncology drugs.
Action Required
By 04/20/2026: Billing team and clinical staff must review the full MA08.148c policy text at the provided URL to identify specific HCPCS codes, medical necessity criteria, and any prior authorization requirements for Amivantamab-vmjw and Amivantamab and hyaluronidase-lpuj. Update billing system rules, prior authorization protocols, and provider documentation templates based on the specific coding and medical necessity updates outlined in the policy. Ensure all oncology and infusion center staff are trained on the new requirements before the effective date. Claims submitted without compliance to updated medical necessity criteria may be denied.