Publication Date: 

Please note, this communication applies to Healthy Blue + MedicareSM (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina.

Effective on and after January 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and Centers for Medicare and Medicaid Services guidelines — including definitions and specific contract provisions/exclusions — take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

HCPCS or CPT® code Medicare Part B drugs
J9353 J9353 Margenza
J3490, J3590, C9076 Breyanzi
J3490, J3590, C9075 Amondys 45
J3490, J3590, C9399 Nulibry
Q5123 Riabni
C9399, J3490, J3590, J9999 Abecma
J3490, J9999, C9080 Pepaxto
J3490, C9078 Cosela
J3490, C9079 Evkeeza
J3490, J3590, J9999 Zynlonta
J3490, J3590, J9999 Jemperli
J3490, J3590, C9399 Empaveli
J9999 Rybrevant

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BNCCARE-0202-21 September 2021 519441MUPENMUB