Medicare AdvantageCoverageMedium impact
MA08.115b, Teprotumumab (Tepezza®)
Independence Blue Cross·Endocrinology, Ophthalmology·Pharmacy
Effective date
Jan 6, 2025
We identified it
Jun 19, 2026
Summary
Medicare Advantage policy MA08.115b for Teprotumumab (Tepezza®) has been updated with changes to coverage criteria, medical necessity requirements, and coding guidelines. This affects billing and authorization processes for this thyroid eye disease medication.
Action Required
By January 6, 2025: Billing team must review updated MA08.115b policy for Teprotumumab (Tepezza®) to understand new coverage criteria and medical necessity requirements. Update prior authorization workflows and ensure proper documentation requirements are met for Medicare Advantage claims. Verify coding guidelines are current in billing system.