Medicare AdvantageCoverageMedium impact
MA08.179a, Guselkumab (Tremfya®) Injection for Intravenous Use
Independence Blue Cross·MA · Dermatology, Rheumatology, Gastroenterology·Pharmacy
Effective date
Apr 1, 2026
We identified it
Jun 19, 2026
Summary
This is a reissue of policy MA08.179a regarding Guselkumab (Tremfya®) Injection coverage under Medicare Advantage plans, effective April 1, 2026. The billing team must review the full policy text to identify specific coverage requirements, prior authorization mandates, or billing code changes that may affect claim submission and reimbursement for this biologic injection.
Action Required
By March 15, 2026: Billing team must obtain and review the complete MA08.179a policy text from the provided URL to identify: (1) specific HCPCS J-codes for Guselkumab administration and dosing, (2) prior authorization requirements, (3) covered indications, and (4) any documentation requirements. Update billing software and prior auth workflows accordingly. Providers must be notified of any new requirements. Failure to implement required prior authorization or use correct coding will result in claim denials effective April 1, 2026.