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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Rheumatology, Oncology, Internal MedicineMedium impact

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

Act
by Sep 15, 2025
Effective date
Oct 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated Medicare Advantage policy MA08.070f to MA08.070g, adding ICD-10 code M05.A (Abnormal rheumatoid factor and anti-citrullinated protein antibody with rheumatoid arthritis) to the covered diagnosis codes for Golimumab (Simponi Aria) IV injection. This expands coverage criteria for rheumatoid arthritis patients. The policy becomes effective October 1, 2025.

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What to do

by Sep 15, 2025 · 4 steps
01Billing team must update diagnosis code validation rules in the billing system to recognize M05.A as a covered indication for HCPCS code J1602 (Golimumab IV injection) under Medicare Advantage plans.
02Update prior authorization templates and claims submission protocols to include M05.A as an acceptable diagnosis code.
03Providers should update encounter documentation templates to facilitate proper coding of this condition.
04After October 1, 2025, claims with M05.A as the primary diagnosis for J1602 should no longer require denial due to non-covered diagnosis codes, provided all other medical necessity criteria in policy MA08.070g are met.

Codes mentioned

J1602M05.A

Original notice

MA08.070f, Golimumab (Simponi Aria®) Intravenous (IV) Injection
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
MA08.070g, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · Pharmacy08.01.15g, Golimumab (Simponi Aria®) Intravenous (IV) InjectionMediumEffective Oct 1, 2025 · Pharmacy08.01.15h, 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 policiesRheumatologyOncologyInternal MedicineCode J1602Code M05.A

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