Medicare AdvantagePrior AuthHigh impact
MA08.120e, Nivolumab (Opdivo®), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™)
Independence Blue Cross·Oncology, Hematology·Pharmacy
Effective date
Mar 24, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.120e for Nivolumab (Opdivo®) and Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™) has been updated with changes to medical necessity criteria, medical coding requirements, and general guidelines. This affects oncology practices billing for these immunotherapy medications under Medicare Advantage plans.
Action Required
By March 24, 2025: Oncology billing teams must review and implement updated medical necessity criteria and coding requirements for Nivolumab (Opdivo®) and Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig™) for Medicare Advantage patients. Access the full policy at the provided URL to update prior authorization protocols, documentation requirements, and billing procedures. Ensure all staff are trained on new criteria to prevent claim denials.