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Independence Blue CrossMedicare Advantage · Billing Codes · Pharmacy · Oncology, Hematology, Pediatrics +1 moreMedium impact

MA08.085i, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)

Act
by Jan 1, 2025
Effective date
Jan 1, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated MA08.085i to MA08.085k effective 01/01/2025, discontinuing coverage for the older Erwinaze® formulation (HCPCS J9010) due to manufacturer discontinuation, and revising medical necessity criteria for Rylaze® (HCPCS J9021) based on updated FDA labeling and NCCN guidelines. Billing teams must stop billing the discontinued Erwinaze code and ensure Rylaze claims meet updated hypersensitivity and contraindication criteria.

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What to do

by Jan 1, 2025 · 9 steps
01Billing team must immediately remove HCPCS code J9010 (Erwinaze) from all billing systems and encounter templates.
02Stop accepting or processing any claims with J9010 — these will be denied as the drug is no longer manufactured.
03Update billing software to flag J9010 as non-reimbursable.
04For HCPCS J9021 (Rylaze): Verify all claims include documentation of hypersensitivity to E.
05coli-derived asparaginase (Asparlas or Oncaspar) and absence of contraindications (prior serious hypersensitivity to Rylaze, prior serious pancreatitis, prior serious hemorrhage/thrombosis during L-asparaginase therapy, or severe hepatic impairment).
06Add medical necessity checklist to prior authorization templates.
07Communicate with oncology providers that Rylaze now requires documented E.
08coli asparaginase hypersensitivity as a prerequisite for coverage.
09Claims lacking this documentation or indicating contraindications will be denied.

Codes mentioned

J9010J9021

Original notice

MA08.085i, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related changes

See all Independence Blue Cross changes →
08.01.35i, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)MediumEffective Jan 1, 2025 · PharmacyMA08.085j, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)MediumEffective Aug 25, 2025 · PharmacyMA08.085k, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)LowEffective Jan 1, 2026 · PharmacyMA08.085k, Asparaginase Erwinia Chrysanthemi (recombinant)-rywn (Rylaze®)MediumEffective Jan 1, 2026 · PharmacyBrowse every Independence Blue Cross change in the policy list

Related policy hubs

Independence Blue Cross policiesOncologyHematologyPediatricsPharmacyCode J9010Code J9021

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