Medicare AdvantageCoverageMedium impact
MA08.004z, Coagulation Factors
Independence Blue Cross·Hematology, Pharmacy, Pediatrics +1 more·Medical Policy
Effective date
Jan 1, 2026
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage updated policy MA08.004z effective 01/01/2026 to add coverage for two new hemophilia treatment products: Concizumab-mtci (Alhemo) and Fitusiran (Qfitlia). The policy adds HCPCS code J7174 for fitusiran and clarifies that Concizumab-mtci uses unclassified drug codes (C9399, J3590). All ICD-10 diagnosis codes have been removed from the policy; providers must now report the most appropriate diagnosis code based on medical necessity criteria.
Action Required
By 01/01/2026: Billing team must update billing software to recognize and process HCPCS code J7174 (Injection fitusiran 0.04 mg) for hemophilia A or B with or without factor VIII or IX inhibitors. Update claim submission procedures to use unclassified drug codes C9399 or J3590 for Concizumab-mtci (Alhemo) until permanent codes are assigned. Remove all hard-coded ICD-10 diagnosis codes from templates; ensure providers select and document the most appropriate diagnosis code (e.g., D66, D67, or D68.311-D68.318) based on hemophilia type and inhibitor status to support medical necessity at time of claim submission. Update prior authorization processes if applicable. Train billing staff on new product coverage under medical benefit (Part B) only for Medicare Advantage members. Failure to properly code fitusiran or to document appropriate diagnosis codes will result in claim denials.