← Back to list
MA08.183, Zenocutuzumab-zbco (Bizengri®)
Act
by Jul 28, 2025
Effective date
Jul 28, 2025
Identified
Jun 19, 2026
Summary
Independence Blue Cross has published MA08.183a, a new Medicare Advantage coverage policy for zenocutuzumab-zbco (Bizengri®), establishing medical necessity criteria for NRG1 gene fusion–positive non-small cell lung cancer and pancreatic adenocarcinoma. Billing teams must verify patients meet specific criteria including prior systemic therapy progression, LVEF ≥50%, and applicable performance status before claims are submitted. This supersedes the previous MA08.183 version and becomes effective July 28, 2025.
Get alerts when payers change rules like this one
We check Independence Blue Cross and other payers every day and email you when a change matches your specialty and state.
Get Independence Blue Cross alertsPolicy Monitoring is free. No card required.
What to do
by Jul 28, 2025 · 11 steps
01Billing team must implement updated authorization protocols for HCPCS code J9382 (zenocutuzumab-zbco).
02Providers and billing staff must verify the following before claim submission.
03Patient has NRG1 gene fusion–positive disease confirmed by genetic testing.
04Disease progression documented on or after prior systemic therapy.
05LVEF ≥50% documented within clinical record prior to treatment initiation.
06For NSCLC: no additional PS requirements.
07For pancreatic adenocarcinoma: ECOG PS 0-1 or PS 2 documented, and treatment scenario clearly identified (local recurrence post-resection, recurrent metastatic disease, or locally advanced/metastatic disease).
08Update billing system to flag claims for J9382 requiring pre-authorization documentation verification.
09Add checklist to provider encounter templates specifying required clinical documentation.
10Claims submitted without complete medical necessity documentation will be denied.
11All claims referencing ICD-10 diagnosis codes C25.x or C33-C34.x for this drug must include supporting genetic testing reports and LVEF results.
Codes mentioned
J9382C25.0C25.1C25.2C25.3C25.7C25.8C25.9C33C34.01C34.02C34.11
Original notice
MA08.183, Zenocutuzumab-zbco (Bizengri®)
medpolicy.ibx.com · Always check the source before changing claims.
Related changes
See all Independence Blue Cross changes →MA08.183a, Zenocutuzumab-zbco (Bizengri®)MediumEffective Jun 1, 2026 · Pharmacy08.02.38, Zenocutuzumab-zbco (Bizengri®)MediumEffective Jul 28, 2025 · Pharmacy08.02.38a, Zenocutuzumab-zbco (Bizengri®)MediumEffective Jun 1, 2026 · PharmacyMA08.185a, Datopotamab deruxtecan (Datroway®)MediumEffective Nov 2, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list