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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · NJ · Neurology, Rheumatology, Allergy & Immunology +1 moreHigh impact

MA08.126c, Inebilizumab-cdon (Uplizna®)

Effective date
Mar 23, 2026
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.126c to expand Uplizna® (inebilizumab-cdon) coverage to include two new FDA-approved indications: immunoglobulin G4-related disease (IgG4-RD) and generalized myasthenia gravis (gMG), in addition to the existing NMOSD indication. All ICD-10 diagnosis codes were removed from the policy; billing teams must now report the most appropriate diagnosis code supporting medical necessity criteria. Effective immediately (03/23/2026).

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What to do

Action · 5 steps
01By 03/23/2026: Billing team must update systems and authorization workflows to recognize three covered indications for HCPCS J1823 (inebilizumab-cdon): NMOSD, IgG4-RD, and gMG.
02For each indication, verify that prior authorization requests include the specific medical necessity criteria outlined in the policy (e.g., AQP4 antibody seropositivity and relapse history for NMOSD; glucocorticoid requirement and multi-organ involvement for IgG4-RD; autoantibody presence and MGFA Class II-IV with specified MG-ADL scores for gMG).
03Remove any hardcoded ICD-10 code restrictions from billing software; ensure providers submit appropriate diagnosis codes with claims in support of medical necessity criteria.
04Revise authorization templates to reflect all three indications and their respective requirements.
05Notify referring providers (neurology, rheumatology, immunology) of the expanded coverage and new criteria requirements.
If missed: Failure to update authorization logic may result in claim denials for newly eligible gMG and IgG4-RD cases.

Codes mentioned

J1823

Original notice

MA08.126c, Inebilizumab-cdon (Uplizna®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.01.68b, Inebilizumab-cdon (Uplizna)LowNo effective date · Pharmacy08.01.68c, Inebilizumab-cdon (Uplizna®)HighEffective Mar 23, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesNJ policy changesNeurologyRheumatologyAllergy & ImmunologyPharmacyCode J1823

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