Medicare AdvantageAdministrativeLow impact
MA08.143b, Tebentafusp-tebn (Kimmtrak®)
Independence Blue Cross·NJ · Oncology, Pharmacy·Pharmacy
We identified it
Jun 19, 2026
Summary
This is a reissue with no substantive changes to MA08.143b covering tebentafusp-tebn (Kimmtrak®) for HLA-A*02:01-positive uveal melanoma. The policy was reissued on 11/26/2025 as part of the annual review process. The active HCPCS code is J9274 (replacing deprecated codes C9095 and J9999). No workflow changes are required.
Action Required
No immediate action required. This is a reissue with no changes to coverage criteria, documentation requirements, or billing guidelines. Confirm your billing system is using HCPCS code J9274 for tebentafusp-tebn claims. Verify that prior claims incorrectly billed to C9095 or J9999 have been corrected to J9274. Continue to enforce the existing requirement: tebentafusp-tebn is covered only as first-line treatment for unresectable/metastatic uveal melanoma in HLA-A*02:01-positive patients with no prior systemic therapy. All other uses require documentation of accepted off-label indication or will be denied as experimental/investigational.