Medicare AdvantageDocumentationMedium impact
MA08.047m, Pemetrexed (Pemfexy™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Nov 17, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.047m for Pemetrexed (Pemfexy™) has been updated with changes to medical necessity criteria and medical coding requirements. This affects how the chemotherapy drug Pemfexy must be documented and potentially coded for billing purposes.
Action Required
By November 17, 2025: Billing team and oncology providers must review the updated medical necessity criteria for Pemetrexed (Pemfexy™) at the provided policy URL. Update documentation templates and billing procedures to ensure compliance with new medical coding requirements. Verify proper coding and documentation before submitting claims to avoid denials.