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Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · Allergy & Immunology, Pulmonology, Pediatrics +2 moreMedium impact

MA08.025h, Omalizumab (Xolair®)

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

Summary

Independence Blue Cross updated Medicare Advantage policy MA08.025h to MA08.025i, replacing generic ICD-10 codes for milk and egg allergies (Z91.011, Z91.012) with more specific codes that differentiate between unspecified allergies and those with tolerance or reactivity to baked products. This change affects diagnosis code reporting for omalizumab coverage claims but does not alter coverage criteria or medical necessity requirements.

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What to do

by Oct 1, 2025 · 5 steps
01Billing team must update diagnosis code reporting in all billing systems and claim submission workflows.
02When submitting omalizumab claims for patients with milk or egg allergies, discontinue use of generic codes Z91.011 and Z91.012.
03Instead, use the appropriate specific codes: Z91.0110, Z91.0111, or Z91.0112 for milk allergies; Z91.0120, Z91.0121, or Z91.0122 for egg allergies, based on documented allergy type and baked product tolerance status.
04Update claim scrubbing logic to reject claims containing the old codes (Z91.011, Z91.012).
05Notify providers to ensure clinical documentation specifies whether patients have tolerance or reactivity to baked milk/egg products.
If missed: Failure to use correct ICD-10 codes may result in claim denials or rejections during processing.

Codes mentioned

Z91.0110Z91.0111Z91.0112Z91.0120Z91.0121Z91.0122J2357Q5154

Original notice

MA08.025h, Omalizumab (Xolair®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.025h, Omalizumab (Xolair®)LowEffective Oct 1, 2025 · Pharmacy08.00.55m, Omalizumab (Xolair®)LowEffective Oct 1, 2025 · Pharmacy08.00.55m, Omalizumab (Xolair®)MediumEffective Oct 1, 2025 · PharmacyMA08.025g, Omalizumab (Xolair®)MediumEffective Jan 6, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesAllergy & ImmunologyPulmonologyPediatricsInternal MedicineDermatologyCode Z91.0110Code Z91.0111Code Z91.0112Code Z91.0120Code Z91.0121Code Z91.0122Code J2357Code Q5154

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