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Independence Blue CrossMedicare Advantage · Coverage · Pharmacy · Allergy & Immunology, Pediatrics, Pulmonology +1 moreMedium impact

MA08.025g, Omalizumab (Xolair®)

Act
by Jan 6, 2025
Effective date
Jan 6, 2025
Identified
Jun 19, 2026

Summary

Independence Blue Cross updated Medicare Advantage policy MA08.025g to MA08.025i, expanding Omalizumab (Xolair) coverage to include IgE-Mediated Food Allergy as a new medically necessary indication, revised criteria for Prevention of Anaphylaxis frequency, and added eight new ICD-10 diagnosis codes for food allergies. This change is effective January 6, 2025.

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What to do

by Jan 6, 2025 · 5 steps
01Billing team must update all billing systems and templates to recognize the new ICD-10 diagnosis codes (Z91.010, Z91.011, Z91.012, Z91.013, Z91.014, Z91.018, Z91.02) for food allergy indications.
02Update prior authorization workflows to include IgE-Mediated Food Allergy as a covered indication requiring the same medical necessity criteria as asthma and urticaria.
03Providers must begin documenting food allergy diagnosis using the new codes and ensure baseline IgE levels (30-1500 IU/mL) are obtained.
04Train billing and clinical staff on the revised Prevention of Anaphylaxis frequency criteria (see Attachment A, which is not provided in this document—request from payer).
05Verify that claims submitted on or after January 6, 2025 with these new codes are processed under the expanded coverage; claims submitted without proper documentation of the new indication or IgE levels will be denied.

Codes mentioned

J2357Q5154Z91.010Z91.011Z91.012Z91.013Z91.014Z91.018Z91.02

Original notice

MA08.025g, Omalizumab (Xolair®)
medpolicy.ibx.com · Always check the source before changing claims.
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Related policy hubs

Independence Blue Cross policiesAllergy & ImmunologyPediatricsPulmonologyDermatologyCode J2357Code Q5154Code Z91.010Code Z91.011Code Z91.012Code Z91.013Code Z91.014Code Z91.018Code Z91.02

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