Who is affected by this change?

This affects Independence Blue Cross Endocrinology, Ophthalmology providers on Medicare Advantage plans.

When does this change take effect?

This change is effective Jan 6, 2025.

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Medicare AdvantageCoverageMedium impact

MA08.115b, Teprotumumab (Tepezza®)

Independence Blue Cross·Endocrinology, Ophthalmology·Pharmacy

Effective date

Jan 6, 2025

We identified it

Jun 19, 2026

Days to comply

—

Summary

This is a comprehensive policy update for Teprotumumab (Tepezza®) covering multiple aspects including coverage criteria, medical necessity requirements, coding guidelines, and general policy information for Medicare Advantage plans.

Action Required

Action needed

By January 6, 2025: Billing team must review and implement updated coverage criteria, medical necessity requirements, and coding guidelines for Teprotumumab (Tepezza®) in Medicare Advantage plans. Update prior authorization processes and documentation requirements according to new policy MA08.115b. Verify current billing practices align with updated reimbursement positions.

Related policy hubs

Independence Blue Cross policies Endocrinology Ophthalmology