Medicare AdvantageCoverageMedium impact
MA08.007aq, Medicare Part B vs. Part D Crossover Drugs
Independence Blue Cross·Pharmacy
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage has updated medical necessity criteria and coding requirements for drugs that can be covered under either Medicare Part B or Part D. This policy clarifies billing guidelines for crossover medications to ensure proper claim routing and coverage determination.
Action Required
By January 1, 2025: Billing team must review and update procedures for billing crossover drugs that can be covered under either Medicare Part B or Part D. Verify current medical necessity criteria documentation requirements and ensure proper coding practices are followed to route claims to the correct Medicare benefit. Update staff training on distinguishing between Part B vs Part D drug coverage scenarios.