Medicare AdvantageCoverageHigh impact
MA08.093q, Chimeric Antigen Receptor (CART) Therapy: Yescarta Tecartus, Breyanzi, Kymriah and Aucatzyl
Independence Blue Cross·Oncology, Hematology, Pharmacy·Medical Policy
Effective date
Feb 9, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.093q to expand CAR-T therapy coverage under Medicare Advantage, adding new indications for existing drugs (Yescarta, Tecartus, Breyanzi, Kymriah), introducing a new FDA-approved drug (Aucatzyl with HCPCS code Q2058), and moving coverage for Abecma and Carvykti to a separate policy. The policy title was clarified to specify CAR-T therapy for leukemia and lymphoma.
Action Required
By February 9, 2026: (1) Billing team must update system to recognize new HCPCS code Q2058 (Aucatzyl) as medically necessary for Medicare Advantage claims; (2) Add new ICD-10 diagnosis codes for expanded indications: CLL/SLL for Yescarta and Kymriah, plasmablastic lymphoma subtype for Yescarta/Breyanzi/Kymriah, Richter transformation criteria for Breyanzi; (3) Update prior authorization workflows to reflect new indications per NCCN guidelines; (4) Verify existing codes Q2041, Q2042, Q2053, Q2054 remain active; (5) Confirm CPT codes 38228, 38225, 38226, 38227 billing status (38228 medically necessary; 38225-38227 not separately reimbursed); (6) Locate and implement separate policy for Abecma/Carvykti coverage to avoid duplicate or missed claims. Failure to implement these changes will result in claim denials for Aucatzyl infusions and claims submitted under outdated coverage criteria.