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Blue Cross and Blue Shield of North Carolina Expands Specialty Pharmacy Precertification List
Please note, this communication applies to Healthy Blue + Medicare℠ (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 |
For more information, visit Healthy Blue + Medicare.
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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