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MA08.025h, Omalizumab (Xolair®)
Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.025h to MA08.025i, replacing generic ICD-10 allergy codes (Z91.011, Z91.012) with more specific granular codes that differentiate between unspecified allergies and those with tolerance or reactivity to baked products. This change affects diagnosis code reporting for omalizumab claims but does not alter coverage criteria or billing codes.
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What to do
by Oct 1, 2025 · 3 steps
01Billing team must update diagnosis code selection logic in billing software to use the new granular ICD-10 codes (Z91.0110, Z91.0111, Z91.0112, Z91.0120, Z91.0121, Z91.0122) instead of the deprecated generic codes (Z91.011, Z91.012) when submitting omalizumab claims to Independence Blue Cross Medicare Advantage plans.
02Ensure providers document whether milk or egg allergies involve tolerance or reactivity to baked products to enable accurate code selection.
03Claims submitted with the old generic codes after October 1, 2025 may be denied or require rebilling.
Codes mentioned
Z91.0110Z91.0111Z91.0112Z91.0120Z91.0121Z91.0122J2357Q5154
Original notice
MA08.025h, Omalizumab (Xolair®)
medpolicy.ibx.com · Always check the source before changing claims.
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