Breyanzi requires prior authorization for Medicare Advantage members

For Medicare Plus Blue℠ and BCN Advantage℠ members, we require authorization for the CAR‑T medication Breyanzi^® (lisocabtagene maraleucel), HCPCS code J9999, when administered at on‑campus or off‑campus outpatient hospitals (site of care 19 and 22).

Here’s how to bill:

• Electronically through an 837P transaction or on a professional CMS‑1500 claim form
• Electronically through an 837I transaction or by using the UB04 claim form for a hospital outpatient type of bill 013x

Reminder:

Submit authorization requests for Breyanzi through NovoLogix. It offers real‑time status checks and immediate approvals for certain medications. If you have access to Provider Secured Services, you already have access to enter authorization requests through NovoLogix.

If you need to request access to Provider Secured Services, complete the Provider Secured Access Application form and fax it to the number on the form.

For a list of requirements related to drugs covered under the medical benefit, see the Medical Drug and Step Therapy Prior Authorization List for Medicare Plus Blue PPO and BCN Advantage members.