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Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · Pharmacy, Allergy & Immunology, Rheumatology +2 moreMedium impact

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

Act
by Jul 1, 2025
Effective date
Jul 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated Medicare Advantage policy MA08.007ar (now MA08.007ay) to add three new unapproved vaccine CPT codes (90612, 90613, 91323) marked as experimental/not covered, revise CPT code 90620, and add four new HCPCS codes for ustekinumab biosimilars (Q9999, C9399, J3490, J3590) effective 06/01/2025 retroactively and 07/01/2025 prospectively. Codes marked with asterisks require a JB modifier for claims processing.

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What to do

by Jul 1, 2025 · 6 steps
01Billing team must update claim submission system to reflect that CPT codes 90612, 90613, and 91323 are experimental/investigational and NOT covered under any benefit—configure system to deny or flag claims with these codes.
02For CPT 90620, review revised coverage rules and update billing logic accordingly.
03Effective June 1, 2025 (retroactive): Add new HCPCS codes Q9999, C9399, J3490, and J3590 to system for ustekinumab biosimilar coverage; ensure JB modifier is appended to all claims using C9399, J3490, and J3590.
04Update existing Q9998 code mapping if coverage rules changed.
05Coordinate with providers and pharmacy to communicate that claims submitted without JB modifiers for marked codes will be denied.
06Verify that billing software flags any unapproved vaccine claims for manual review and denial.

Codes mentioned

90612906139132390620Q9998Q9999C9399J3490J3590

Original notice

MA08.007ar, Medicare Part B vs. Part D Crossover Drugs
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

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MA08.042l, Ustekinumab for Intravenous UseHighEffective Jul 1, 2026 · Pharmacy08.00.82q, Ustekinumab for Intravenous InfusionHighEffective Jul 1, 2026 · Pharmacy08.00.82o, Ustekinumab for Intravenous Infusion and Subcutaneous InjectionHighEffective Jul 1, 2025 · Pharmacy08.00.78aw, Self-Administered Drugs and BiologicsMediumEffective Jan 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesPharmacyAllergy & ImmunologyRheumatologyInfectious DiseaseGastroenterologyCode 90612Code 90613Code 91323Code 90620Code Q9998Code Q9999Code C9399Code J3490Code J3590

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