Medicare AdvantagePrior AuthMedium impact
MA08.093p, Chimeric Antigen Receptor (CAR) Therapy
Independence Blue Cross·Oncology, Hematology·Medical Policy
Effective date
Feb 24, 2025
We identified it
Jun 19, 2026
Summary
Policy MA08.093p establishes medical necessity criteria for Chimeric Antigen Receptor (CAR) T-cell therapy, a specialized cancer immunotherapy. This recent policy change (effective 02/24/2025) defines coverage requirements and documentation standards for CAR-T treatments under Medicare Advantage plans. Billing teams must ensure claims include proper medical necessity documentation and prior authorization before treatment.
Action Required
By 02/24/2025: Billing team must implement prior authorization requirements for all CAR-T therapy claims submitted to Medicare Advantage plans. 1) Update billing system to flag CAR-T cases for mandatory prior auth review before claim submission. 2) Coordinate with providers to ensure medical necessity documentation is completed per MA08.093p criteria and attached to all CAR-T authorization requests. 3) Train front-desk and clinical staff to identify CAR-T cases at scheduling and initiate auth process immediately. 4) Create internal checklist of required medical necessity elements per this policy and attach to encounter forms used by oncology providers. Without proper prior authorization and medical necessity documentation, claims will be denied by Medicare Advantage plans.