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Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · Critical Care, Infectious Disease, Internal Medicine +2 moreMedium impact

MA08.045n, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection

Effective date
Jan 24, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated policy MA08.045n to MA08.045r, adding three new HCPCS codes (M0237, M0238, Q0237) for tocilizumab-anoh COVID-19 treatment effective retroactively to 01/24/2025, and replacing two NOC codes (C9399, J3590) with Q5156 for the Avtozma biosimilar. The policy designates tocilizumab-aazg (Tyenne) and tocilizumab-anoh (Avtozma IV) as preferred products with cost-effectiveness considerations for Medicare Advantage members.

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What to do

Action · 5 steps
01By 01/24/2025 (retroactive): Billing team must update claims processing system to recognize and properly bill new HCPCS codes M0237, M0238, and Q0237 for hospitalized COVID-19 patients receiving tocilizumab-anoh with corticosteroids and supplemental oxygen/mechanical ventilation/ECMO.
02Replace any previous claims using C9399 or J3590 for Avtozma with the new code Q5156.
03Verify billing software can distinguish between preferred products (Tyenne IV, Avtozma IV) and nonpreferred products (Actemra IV, Tofidence IV) to ensure appropriate coverage determination.
04Train providers and billing staff on the new codes and preferred/nonpreferred product hierarchy.
05Effective 10/01/2025: Implement the full revised policy version MA08.045r in all systems.
If missed: Failure to use correct codes may result in claim denials or payment delays.

Codes mentioned

M0237M0238Q0237Q5156C9399J3590J3262

Original notice

MA08.045n, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous Injection
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.00.85r, Tocilizumab and Related Biosimilars for Intravenous InfusionHighEffective Oct 1, 2025 · PharmacyMA08.045m, Tocilizumab and Related Biosimilars for Intravenous Infusion and Subcutaneous InjectionMediumEffective Jul 1, 2025 · PharmacyMA08.172, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · Pharmacy08.02.22, Lifileucel (Amtagvi™)LowEffective Oct 21, 2024 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesCritical CareInfectious DiseaseInternal MedicinePharmacyRheumatologyCode M0237Code M0238Code Q0237Code Q5156Code C9399Code J3590Code J3262

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