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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Oncology, Hematology, PharmacyMedium impact

MA08.158c, Mosunetuzumab-axgb (Lunsumio™)

Act
by Jun 16, 2025
Effective date
Jun 16, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.158c to expand Lunsumio (mosunetuzumab-axgb) coverage to include three new indications: Diffuse Large B-Cell Lymphoma, High-Grade B-Cell Lymphomas, and HIV-Related B-Cell Lymphomas, in addition to the existing Follicular Lymphoma coverage. Criteria for Classic Follicular Lymphoma were revised. All ICD-10 codes were removed from the policy; billing teams must report the most appropriate diagnosis code supporting medical necessity. Billing code remains J9350.

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What to do

by Jun 16, 2025 · 5 steps
01Billing team must update claim submission processes and prior authorization templates to reflect the three new covered indications (Diffuse Large B-Cell Lymphoma, High-Grade B-Cell Lymphomas, HIV-Related B-Cell Lymphomas) in addition to Classic Follicular Lymphoma.
02For all Lunsumio claims billed with HCPCS code J9350, ensure the most appropriate ICD-10 diagnosis code supporting medical necessity criteria listed in the policy is reported on each claim.
03Update any internal coverage lists or EMR templates to reflect the expanded indications.
04Verify that prior authorization workflows require documentation of medical necessity criteria specific to each indication (e.g., for DLBCL: second-line therapy with Polivy, relapsed disease timing, or CAR T-cell ineligibility; for Follicular Lymphoma: confirmation of grades 1-3a, prior systemic therapy requirements, and treatment indications).
05Claims submitted without appropriate diagnosis codes or without meeting the specific criteria for the indicated condition will be denied.

Codes mentioned

J9350

Original notice

MA08.158c, Mosunetuzumab-axgb (Lunsumio™)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.02.00c, Mosunetuzumab-axgb (Lunsumio™)MediumEffective Jun 16, 2025 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOncologyHematologyPharmacyCode J9350

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