Medicare AdvantageDocumentationMedium impact
MA08.122e, Avelumab (Bavencio®)
Independence Blue Cross·MA · Oncology, Pharmacy·Pharmacy
Effective date
Dec 29, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.122e for Avelumab (Bavencio®) has been updated effective 12/29/2025 with changes to medical necessity criteria and medical coding requirements. The billing team must review updated coverage criteria and ensure claims are coded and documented according to new guidelines to avoid denials on Medicare Advantage plans.
Action Required
By 12/29/2025: Billing team and clinical staff must review the full policy text at https://medpolicy.ibx.com/ibc/ma/Pages/Site-Activity-View.aspx?FilterField1=MPSiteActivityLogMonth&FilterValue1=12&FilterField2=MPSiteActivityLogYear&FilterValue2=2025#medicare-advantage-ma08-122e-avelumab-bavencio to identify specific medical necessity criteria and coding requirements for Avelumab (Bavencio®) claims. Update billing system rules and EMR templates to reflect new medical necessity documentation requirements. Train billing and clinical staff on new criteria. Ensure all prior authorizations submitted after 12/29/2025 include documentation meeting updated medical necessity standards. Claims submitted without proper documentation will be denied.