Medicare AdvantageCoverageMedium impact
MA08.148b, Amivantamab-vmjw (Rybrevant®)
Independence Blue Cross·Oncology, Pulmonology, Pharmacy·Pharmacy
Effective date
Jul 28, 2025
We identified it
Jun 19, 2026
Summary
Independence Blue Cross updated MA08.148b to MA08.148d effective July 28, 2025, expanding coverage criteria for amivantamab (Rybrevant) to include first-line combination therapy with lazertinib for EGFR exon 19 deletion or exon 21 L858R mutations, plus continuation therapy for limited progression. ICD-10 diagnosis codes have been removed from the policy; billing teams must report the most appropriate diagnosis code based on medical necessity criteria.
Action Required
By July 28, 2025: Billing team must update prior authorization and claim submission workflows to reflect expanded coverage criteria for amivantamab (HCPCS J9061, J9062). Providers should document one of the following indications in support of claims: (1) First-line treatment in combination with lazertinib for locally advanced/metastatic NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation; (2) Subsequent therapy following EGFR TKI progression; or (3) Continuation therapy following amivantamab-vmjw plus lazertinib progression with asymptomatic, brain, or limited systemic disease. Remove any references to version MA08.148b from billing systems and encounter documentation. Ensure providers report the most appropriate ICD-10 diagnosis code supporting medical necessity (ICD-10 codes are no longer listed in policy; use standard NSCLC codes). Claims submitted without appropriate indication or after July 28, 2025 using old criteria may be denied.