Medicare AdvantageAdministrativeLow impact
MA08.033d, Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio)
Independence Blue Cross·Genetics, Endocrinology, Nephrology +3 more·Medical Policy
We identified it
Jun 19, 2026
Summary
This is a reissue with no substantive changes to Independence Blue Cross Medicare Advantage Policy MA08.033d covering Fabrazyme and Elfabrio for Fabry disease. The policy was last updated on 03/04/2026 per the annual review process. Billing teams should verify their systems reflect the two HCPCS codes (J0180 and J2508) and coverage criteria for both medications, but no immediate workflow changes are required.
Action Required
No immediate action required. This is a routine annual policy reissue with no content changes. Billing team should verify that both HCPCS codes J0180 (Fabrazyme) and J2508 (Elfabrio) are active in the billing system for Independence Blue Cross Medicare Advantage plans, and that claims processing rules correctly enforce the documented medical necessity criteria (diagnosis confirmation, specialist prescription requirement for Elfabrio, dosing of 1 mg/kg IV every 2 weeks, and no concurrent migalastat use). No changes to prior authorization processes, documentation requirements, or reimbursement rates have occurred.