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Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · Endocrinology, Cardiology, Internal Medicine +2 moreMedium impact

MA08.133d, Evinacumab-dgnb (Evkeeza®)

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated policy MA08.133d for Evinacumab-dgnb (Evkeeza) effective 10/01/2025, replacing the ICD-10 diagnosis code E78.01 (Familial hypercholesterolemia) with E78.010 (Homozygous familial hypercholesterolemia [HoFH]). This diagnostic code change requires billing teams to use the more specific HoFH code for all claims going forward. The policy itself was reissued 12/10/2025 with no substantive coverage criteria changes.

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What to do

by Oct 1, 2025 · 5 steps
01Billing team must update all systems, claim templates, and authorization workflows to replace ICD-10 code E78.01 with E78.010 for Evkeeza claims.
02This applies to all Evinacumab-dgnb (Evkeeza) prior authorizations and claims submission.
03Verify that billing software and EMR systems reflect the new diagnosis code.
04Claims submitted with the old code E78.01 after the effective date may be subject to denial or delay.
05Notify providers to document the diagnosis as 'Homozygous familial hypercholesterolemia [HoFH]' rather than generic familial hypercholesterolemia on all Evkeeza referrals and prior authorization requests.

Codes mentioned

J1305E78.010

Original notice

MA08.133d, Evinacumab-dgnb (Evkeeza®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.133e, Evinacumab-dgnb (Evkeeza®)MediumEffective Nov 2, 2026 · Pharmacy08.01.76e, Evinacumab-dgnb (Evkeeza®)MediumEffective Nov 2, 2026 · PharmacyMA08.133d, Evinacumab-dgnb (Evkeeza®)MediumEffective Oct 1, 2025 · Pharmacy08.01.76d, Evinacumab-dgnb (Evkeeza®)MediumEffective Oct 1, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesEndocrinologyCardiologyInternal MedicinePediatricsPharmacyCode J1305Code E78.010

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