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MA08.022s, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.022s to MA08.022t, effective 10/01/2025 and 10/29/2025, with ICD-10 diagnosis code changes for rituximab coverage. The broad diagnosis code G35 (Multiple sclerosis) was removed and replaced with the more specific G35.A (Relapsing-remitting multiple sclerosis), and a new rheumatoid arthritis code M05.A was added. Billing teams must update systems to reflect these revised diagnosis codes for rituximab authorization and claims processing.
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What to do
by Oct 1, 2025 · 7 steps
01Billing team must update the practice management system and prior authorization workflows to reflect ICD-10 diagnosis code changes.
02Remove G35 (Multiple sclerosis) from rituximab coverage criteria and replace with G35.A (Relapsing-remitting multiple sclerosis).
03Add M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis) as a covered diagnosis for rituximab.
04Update encounter forms, templates, and prior authorization submission rules in billing software.
05Verify all pending and future rituximab claims use the updated diagnosis codes (J9311, J9312, Q5115, Q5119, Q5123).
06Train billing staff on the new code requirements.
07Claims submitted with the removed G35 code may be denied; ensure providers document the specific MS type at time of service.
Codes mentioned
J9311J9312Q5115Q5119Q5123G35.AM05.A
Original notice
MA08.022s, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →08.00.50ae, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MediumEffective Oct 29, 2025 · PharmacyMA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MediumEffective Jan 1, 2026 · Pharmacy08.00.50af, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)MediumEffective Jan 1, 2026 · PharmacyMA08.022t, Rituximab (Rituxan®) Infusion and Related Biosimilars, and Rituximab/Hyaluronidase Human for Subcutaneous Injection (Rituxan Hycela®)HighEffective Jan 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list