Medicare AdvantageAdministrativeLow impact
MA08.152d, Nivolumab and relatlimab-rmbw (Opdualag™) for intravenous use
Independence Blue Cross·Oncology, Dermatology·Pharmacy
Effective date
Jun 16, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross reissued MA08.152d with no substantive coverage changes to Opdualag (nivolumab and relatlimab-rmbw) for melanoma treatment. The policy was updated to align with NCCN guidelines dated 01/28/2025, and all ICD-10 diagnosis codes were removed as informational only—billing teams must report the most appropriate diagnosis code supporting medical necessity. The policy applies to Medicare Advantage members when the drug is covered under the medical benefit (Part B), not the pharmacy benefit (Part D).
Action Required
No immediate billing workflow changes required. However, billing team should verify: (1) Claims for Opdualag (J9298) are being submitted under the medical benefit (Part B) and not the pharmacy benefit (Part D) for Independence Blue Cross Medicare Advantage members; (2) When submitting claims, ensure the most appropriate ICD-10 diagnosis code supporting one of the covered indications (unresectable/metastatic melanoma for first-line/second-line/re-induction therapy, or resectable melanoma for neoadjuvant therapy) is reported in support of medical necessity; (3) Documentation in the patient's medical record reflects that the treatment meets one of the specific covered criteria outlined in the policy. No changes to billing software, prior authorization processes, or claim submission procedures are needed at this time, as this is a reissuance with no changes to coverage criteria.