Summary
Independence Blue Cross added three ICD-10 diagnosis codes (H05.831, H05.832, H05.833) for thyroid orbitopathy to policy MA08.115c effective 10/01/2025. These codes specify laterality (right orbit, left orbit, bilateral) for Teprotumumab (Tepezza) claims and must be used alongside existing thyrotoxicosis codes to support medical necessity for coverage.
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What to do
Action · 4 steps
01By 10/01/2025: Billing team must update claim submission logic and encounter templates to require one of the three new ICD-10 thyroid orbitopathy codes (H05.831, H05.832, H05.833) when billing HCPCS code J3241 for Teprotumumab.
02Train providers and clinical staff to document laterality of thyroid orbitopathy at time of service.
03Update billing system to validate that claims include at least one thyrotoxicosis code (E05.xx) AND one thyroid orbitopathy code (H05.83x) for proper medical necessity substantiation.
04Verify claims submitted before 10/01/2025 using old coding practices are processed under prior rules; reject or correct claims on or after effective date missing required laterality codes, as these will be denied by Independence Blue Cross Medicare Advantage.
Codes mentioned
H05.831H05.832H05.833J3241
Original notice
MA08.115c, Teprotumumab (Tepezza®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
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