Medicare AdvantageCoverageMedium impact
MA08.190, Chimeric Antigen Receptor T-cell (CAR-T) Therapy: Carvykti® and Abecma®
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Feb 9, 2026
We identified it
Jun 19, 2026
Summary
This is a new Medicare Advantage policy (MA08.190) effective 02/09/2026 establishing coverage guidelines for Chimeric Antigen Receptor T-cell (CAR-T) therapies, specifically Carvykti® and Abecma®. The billing team must implement coverage requirements and prior authorization protocols for these specialized oncology drugs when they become effective.
Action Required
By 02/09/2026: Billing team must obtain and review the full policy text at the provided URL to extract specific billing codes (J-codes for Carvykti® and Abecma®), prior authorization requirements, and medical necessity criteria. Update billing system to flag CAR-T therapy claims for prior authorization review. Notify oncology providers and hematology-oncology staff of coverage requirements and documentation standards. Configure claim submission workflows to route CAR-T therapy claims to the authorization queue. Without prior authorization implementation, CAR-T therapy claims will be denied by Medicare Advantage plans.