Medicare AdvantageCoverageMedium impact
MA08.042k, Ustekinumab for Intravenous Use
Independence Blue Cross·Dermatology, Gastroenterology, Rheumatology·Pharmacy
Effective date
Jul 1, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage plans have updated their policy for intravenous Ustekinumab, changing coverage criteria, medical necessity requirements, and billing codes. This affects how providers prescribe, document, and bill for IV Ustekinumab treatments.
Action Required
By July 1, 2025: Review the complete policy document at the provided URL to understand specific changes to coverage criteria and medical necessity requirements for intravenous Ustekinumab. Update billing procedures, prior authorization workflows, and provider documentation requirements based on the new guidelines. Ensure staff are trained on any new coding or reimbursement changes.