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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · PA · Pharmacy, Rheumatology, Dermatology +2 moreMedium impact

MA08.007as, Medicare Part B vs. Part D Crossover Drugs

Effective date
Sep 22, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.007as policy to add three new ustekinumab biosimilar HCPCS codes (Q5099, Q5098, Q5100) to Attachment B, classifying them as Part D only (excluded from Part B coverage) with retroactive dates of 07/01/2025 and 08/31/2025. The policy also added CPT code 90635 to Attachment C for vaccines controlled by the Strategic National Stockpile, effective 07/01/2025. Unclassified drug codes (C9399, J3490, J3590) were removed for Steqeyma.

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What to do

Action · 7 steps
01By 09/22/2025: Billing team must update claims processing system and billing software to recognize Q5099 (Steqeyma), Q5098 (Imuldosa), and Q5100 (Yesintek) as Part D-only drugs, excluding them from Part B coverage routing.
02Remove routing to Part B for these codes and ensure they route to Part D pharmacy benefit.
03Update claim denial logic to reject Q5099, Q5098, Q5100 if billed under Part B medical benefit.
04Remove legacy unclassified codes C9399, J3490, J3590 from Steqeyma billing records.
05Add CPT 90635 to vaccine coverage protocols in Attachment C.
06Retroactively apply changes to claims dated 07/01/2025 forward.
07Notify providers that ustekinumab biosimilars must be prescribed through Part D pharmacy benefit.
If missed: Failure to implement routing changes will result in incorrect claim adjudication and member confusion regarding drug benefit responsibility.

Codes mentioned

Q5099Q5098Q5100C9399J3490J359090635

Original notice

MA08.007as, Medicare Part B vs. Part D Crossover Drugs
medpolicy.ibx.com · Always check the source before changing claims.
View original ↗

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Related policy hubs

Independence Blue Cross policiesPA policy changesPharmacyRheumatologyDermatologyGastroenterologyInfectious DiseaseCode Q5099Code Q5098Code Q5100Code C9399Code J3490Code J3590Code 90635

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