Medicare AdvantageBilling CodesHigh impact
MA08.007aq, Medicare Part B vs. Part D Crossover Drugs
Independence Blue Cross·Pharmacy·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.007aq clarifies the distinction between Medicare Part B and Part D coverage for crossover drugs, establishing which drugs are covered under each part and how they should be billed. This recent policy (effective 01/01/2025) impacts medical necessity criteria and coding for pharmacy claims on Medicare Advantage plans.
Action Required
By 01/01/2025: Billing team must review policy MA08.007aq to understand Part B vs. Part D drug coverage distinctions for all Medicare Advantage patients. Update billing software rules and encounter documentation templates to reflect correct part assignment for crossover drugs. Pharmacy staff and providers must verify drug coverage source (Part B vs. Part D) before billing to prevent claim denials. Implement internal audit process to verify all pharmacy claims are coded to the correct part. Failure to properly distinguish Part B and Part D drugs will result in claim rejections and payment delays.