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|
|J3490, J3590, C9076||Breyanzi|
|J3490, J3590, C9075||Amondys 45|
|J3490, J3590, C9399||Nulibry|
|C9399, J3490, J3590, J9999||Abecma|
|J3490, J9999, C9080||Pepaxto|
|J3490, J3590, J9999||Zynlonta|
|J3490, J3590, J9999||Jemperli|
|J3490, J3590, C9399||Empaveli|
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BNCCARE-0202-21 September 2021 519441MUPENMUB