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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Oncology, Endocrinology, Internal Medicine +1 moreMedium impact

MA08.090h, Lanreotide (Somatuline® Depot)

Act
by Nov 17, 2025
Effective date
Nov 17, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.090h to MA08.090i, expanding lanreotide (Somatuline® Depot) coverage criteria for neuroendocrine and adrenal tumors in alignment with NCCN guidelines. All ICD-10 codes were removed from the policy document; billing teams must now report the most appropriate diagnosis code based on the medical necessity criteria listed. This affects coverage for GEP-NETs, carcinoid tumors, and pituitary tumors with new treatment scenarios.

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What to do

by Nov 17, 2025 · 5 steps
01Billing team must update internal references from policy MA08.090h to MA08.090i in all systems and documentation.
02Remove any cached ICD-10 code lists from MA08.090h (Attachment A was removed).
03Providers must be instructed to document diagnosis codes that align with the updated medical necessity criteria—specifically for neuroendocrine and adrenal tumors, carcinoid tumors, GEP-NETs, and pituitary adenomas.
04Update prior authorization submission templates to require providers to reference the specific coverage criteria (e.g., 'unresectable GEP-NET with low tumor burden' or 'carcinoid syndrome with inadequate response to rescue therapy').
05Verify that J1930 and J1932 billing code usage is supported by documented medical necessity matching the policy indications.
If missed: Failure to align documentation with updated NCCN-aligned criteria may result in claim denials or requests for additional medical records.

Codes mentioned

J1930J1932

Original notice

MA08.090h, Lanreotide (Somatuline® Depot)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.090i, Lanreotide (Somatuline Depot)MediumEffective Sep 4, 2026 · Medical Policy08.01.40i, Lanreotide (Somatuline Depot)MediumEffective Sep 4, 2026 · Medical Policy08.01.40h, Lanreotide (Somatuline® Depot)MediumEffective Nov 17, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOncologyEndocrinologyInternal MedicinePharmacyCode J1930Code J1932

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