Specialty Pharmacy Precertification List Expansion Effective April 1 (Healthy Blue + Medicare HMO D-SNP)
Please note, this communication applies to Healthy Blue + Medicare℠ (HMO D-SNP) offered by Blue Cross and Blue Shield of North Carolina (Blue Cross NC).
Effective for dates of service on and after April 1, 2023, 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 CMS 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® codes | Medicare Part B drugs |
|---|---|
C9399, J3490, J3590 | Spevigo (spesolimab-sbzo) |
C9399, J3490, J3590 | Xenpozyme (olipudase alfa) |
For more information, please visit Healthy Blue + Medicare.
NCBCBS-CR-008578-22-CPN8058 December 2022
Blue Cross and Blue Shield of North Carolina does not discriminate on the basis of race, color, national origin, sex, age or disability in its health programs and activities. Learn more about our non-discrimination policy and no-cost services available to you.
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