Authorization for Fasenra™ and Luxturna™ required for Medicare Advantage members starting in August

As communicated in a May web-DENIS message, for dates of service on or after Aug. 7, 2018, authorization will be required for the following Part B specialty drugs covered under the medical benefit for Medicare Plus Blue^SM PPO and BCN Advantage^SM members:

Fasenra (benralizumab)
Luxturna (voretigene neparvovec-rzyl)

Authorization for these drugs is already required for Blue Cross Blue Shield of Michigan and Blue Care Network commercial members.

For Medicare Plus Blue and BCN Advantage members, these medications require authorization when they are billed on a professional HCFA 1500 claim form or by electronic submission via ANSI 837P for these sites of care:

Physician office (place of service 11)
Outpatient facility (place of service 19, 22 and 24 for Medicare Plus Blue members and place of service 19 and 22 BCN Advantage members)

Authorization isn’t required for these medications when they are billed on a facility claim form, such as the UB-92, UB-04 or UCB.

You should bill both medications with procedure code J3590 and submit authorization requests for these medications through the NovoLogix online tool. Authorization must be obtained prior to administering the medications.

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*CPT codes, descriptions and two-digit numeric modifiers only are copyright 2017 American Medical Association. All rights reserved.