Start free

PolicyChanges tracks payer policy changes for medical practices and tells you what to do before they take effect.

Create a free accountPolicy Monitoring is free. No card required.
← Back to list
Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · Pharmacy, Cardiology, Internal Medicine +1 moreMedium impact

MA08.133d, Evinacumab-dgnb (Evkeeza®)

Act
by Oct 1, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated Medicare Advantage policy MA08.133d on October 1, 2025, replacing the ICD-10 diagnosis code E78.01 (Familial hypercholesterolemia) with E78.010 (Homozygous familial hypercholesterolemia [HoFH]) for Evinacumab-dgnb (Evkeeza) coverage. This diagnostic code change requires billing teams to use the more specific HoFH code for all new and existing claims to ensure proper reimbursement under the medical benefit (Part B).

Get alerts when payers change rules like this one

We check Independence Blue Cross and other payers every day and email you when a change matches your specialty and state.

Get Independence Blue Cross alertsPolicy Monitoring is free. No card required.

What to do

by Oct 1, 2025 · 4 steps
01Billing team must update all claim submission systems, superbills, and encounter templates to discontinue use of ICD-10 code E78.01 and replace it exclusively with E78.010 for Evinacumab-dgnb (Evkeeza) claims.
02Update prior authorization templates and clinical documentation guidelines to reflect the new specific code.
03Audit any pending claims using the old code E78.01 and resubmit with E78.010.
04Train providers and clinical staff on the new diagnostic code requirement.
If missed: Failure to use E78.010 may result in claim denials or delays for this rare disease indication.

Codes mentioned

J1305E78.01E78.010

Original notice

MA08.133d, Evinacumab-dgnb (Evkeeza®)
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

See all Independence Blue Cross changes →
MA08.133e, Evinacumab-dgnb (Evkeeza®)MediumEffective Nov 2, 2026 · Pharmacy08.01.76e, Evinacumab-dgnb (Evkeeza®)MediumEffective Nov 2, 2026 · PharmacyMA08.133d, Evinacumab-dgnb (Evkeeza®)MediumEffective Oct 1, 2025 · Pharmacy08.01.76d, Evinacumab-dgnb (Evkeeza®)MediumEffective Oct 1, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPharmacyCardiologyInternal MedicinePediatricsCode J1305Code E78.01Code E78.010

Summaries are AI-assisted. Always confirm against the original payer notice.

What is PolicyChanges

One workspace for payer rules, prior auth, coding and compliance

Medical practices use PolicyChanges to catch payer changes before they cause denials. Every change is summarized in plain English, with the codes involved, the date it takes effect and what to do.

Policy MonitoringPayer policy, prior auth and coding changes, filtered to your saved searchesOIG ScreeningStaff and vendors screened every month against OIG LEIE, SAM.gov and state Medicaid listsPrior Auth LookupKnow if a service needs prior authorization before you schedule itCredentialing TrackerLicenses, CAQH, Medicare revalidation and payer enrollments, with reminders before anything lapsesCompliance CenterKeep your HIPAA program documented and ready to show
Start freePolicy Monitoring is free. No card required.
Get alerts for changes like thisPolicy Monitoring is free. No card required.Create a free account