MA08.018j, Trastuzumab (Herceptin®) and Related Biosimilars, Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta)

By June 16, 2025: Billing team must obtain and review the full policy text from the provided URL to identify specific medical necessity criteria changes and any updated HCPCS codes for trastuzumab products. Update internal billing guidelines and prior authorization templates to reflect new medical necessity requirements. Coordinate with oncology providers to ensure documentation supports medical necessity for all trastuzumab claims submitted on or after the effective date. Claims submitted without updated documentation may be denied. Verify that all trastuzumab and biosimilar claims include appropriate diagnosis codes (HER2-positive breast cancer) and clinical justification per the updated policy.