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Independence Blue CrossMedicare Advantage · Administrative · Pharmacy · Neurology, PharmacyLow impact

MA08.164a, Rozanolixizumab-noli (Rystiggo)

Effective date
Not stated in the notice
Identified
Jun 19, 2026

Summary

Independence Blue Cross reissued MA08.164a on 05/28/2025 with no substantive changes to the rozanolixizumab-noli (Rystiggo) coverage policy. The policy confirms continued coverage for gMG treatment in adults meeting specific clinical criteria. HCPCS code J9333 remains the applicable billing code; obsolete NOC codes (C9399, J3590) were replaced with this code effective 01/02/2024.

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What to do

Action · 5 steps
01No immediate action required.
02This is a reissue with no changes to existing coverage criteria, billing codes, or dosing requirements.
03Verify that billing systems are already configured to use HCPCS code J9333 for rozanolixizumab-noli claims and that the obsolete codes (C9399, J3590) are no longer being used (change was effective 01/02/2024).
04For any new Rystiggo requests, ensure prior authorization documentation includes: confirmed positive AChR or MuSK antibodies, MGFA Class II/III/IVa status, MG-ADL score ≥3, QMG score ≥11, and history of inadequate response or intolerance to standard-of-care therapy or IVIG/PLEX.
05Confirm no concurrent use with eculizumab, ravulizumab, or efgartigimod alfa-fcab.

Codes mentioned

J9333G70.00G70.01

Original notice

MA08.164a, Rozanolixizumab-noli (Rystiggo)
medpolicy.ibx.com · Always check the source before changing claims.
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Related policy hubs

Independence Blue Cross policiesNeurologyPharmacyCode J9333Code G70.00Code G70.01

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