Medicare AdvantageBilling CodesMedium impact
MA05.060d, External Infusion Pumps
Independence Blue Cross·Oncology, Endocrinology, Hematology +3 more·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage policy MA05.060h (superseding MA05.060d) adds HCPCS code J7356 (foscarbidopa/foslevodopa injection) to the external infusion pump coverage criteria, effective retroactively to July 1, 2025. The policy reissued on December 10, 2025 reaffirms the Company's continuing coverage position for external infusion pumps across five indications: chronic iron overload, primary hepatocellular carcinoma, colorectal cancer, intractable cancer pain, and diabetes mellitus.
Action Required
By January 15, 2026: Billing team must update billing system and claim submission software to recognize J7356 (foscarbidopa/foslevodopa) as a covered infusion medication under MA05.060h, retroactive to July 1, 2025. Audit any claims for this drug submitted between 07/01/2025 and the current date; resubmit previously denied or unpaid claims with the updated policy reference. Verify that infusion pump codes (E0779, E0780, E0781, E0784, E0787) are linked to approved diagnoses per the policy: chronic iron overload, unresectable/refused-surgery hepatocellular carcinoma, unresectable/refused-surgery colorectal cancer, intractable cancer pain, or qualifying diabetes mellitus. Train billing staff that this is a Medicare Advantage (Part C) policy only and does not apply to Traditional Medicare or other plan types. Failure to update claims for J7356 retroactively may result in missed revenue recovery and appeal denials.