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Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · NJ · Rheumatology, Internal Medicine, OncologyMedium impact

MA08.070g, Golimumab (Simponi Aria®) Intravenous (IV) Injection

Act
by Sep 30, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross Medicare Advantage policy MA08.070g for Golimumab (Simponi Aria IV) has been updated with a new ICD-10 diagnosis code M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis) effective 10/01/2025. Billing teams must ensure claims for golimumab IV injection include this newly added diagnosis code to support medical necessity for rheumatoid arthritis cases.

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What to do

by Sep 30, 2025 · 5 steps
01Billing team must update diagnosis coding guidelines and claim submission protocols to include ICD-10 code M05.A when billing HCPCS code J1602 for golimumab IV injection in Medicare Advantage members with rheumatoid arthritis.
02Verify that encounter forms and EMR templates include M05.A as a supported diagnosis code for this medication.
03Update billing system edit rules to recognize M05.A as a valid diagnosis for J1602 claims.
04Providers should be notified to document this specific diagnosis code when prescribing Simponi Aria IV for RA patients.
05Claims submitted without updated diagnosis codes may be subject to denial or rejection for incomplete medical necessity documentation.

Codes mentioned

J1602M05.AM06.4

Original notice

MA08.070g, Golimumab (Simponi Aria®) Intravenous (IV) Injection
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

Related changes

See all Independence Blue Cross changes →
08.01.15h, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · PharmacyMA08.070f, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · Pharmacy08.01.15g, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · PharmacyMA08.070h, Golimumab and Related Biosimilars for Intravenous InfusionMediumEffective Oct 19, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesNJ policy changesRheumatologyInternal MedicineOncologyCode J1602Code M05.ACode M06.4

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