Medicare AdvantageBilling CodesLow impact
MA08.029d, Natalizumab (Tysabri®) and Related Biosimilars
Independence Blue Cross·Neurology, Gastroenterology, Pharmacy·Pharmacy
Effective date
Oct 1, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross Medicare Advantage reissued policy MA08.029d for natalizumab (Tysabri) and related biosimilars effective 10/01/2025 with no substantive coverage changes. Three ICD-10 codes were updated to provide more specific multiple sclerosis diagnoses (G35.A, G35.C1, G35.D replacing general G35), which may affect claim coding accuracy but do not change medical necessity criteria or billing requirements.
Action Required
By 10/01/2025: Billing team should update diagnosis code mappings in the billing system to reflect the new ICD-10 codes (G35.A for relapsing-remitting MS, G35.C1 for active secondary progressive MS, G35.D for unspecified MS) and discontinue use of the general G35 code for natalizumab claims. Verify that existing prior authorization workflows for natalizumab (J2323, Q5134) and anti-JCV antibody testing (86711) continue without interruption, as coverage criteria remain unchanged. No claim denials are anticipated from this change, but coding accuracy should be verified in encounter forms and billing templates to ensure proper reimbursement.