Xgeva^® to require authorization for BCN Advantage^SM members

Xgeva (J0897) will continue to require authorization for BCN Advantage members in 2019.

On Nov. 1, 2018, a web-DENIS message and a news item at ereferrals.bcbsm.com were posted indicating that Xgeva would not require authorization starting Jan. 1, 2019, for BCN Advantage members.

However, you'll need to continue to submit authorization requests for this drug. We apologize for any inconvenience this may cause.

We've updated the earlier communications, titled "Medicare Part B medical specialty drug prior authorization lists changing in 2019," to reflect the change. You may want to review the earlier communications to refresh your memory on the other changes that will take place.

Additional information

For BCN Advantage, we require prior authorization for Xgeva when you bill it as a professional service or an outpatient facility service based on the following:

Professional CMS-1500 claim form (or electronically via an 837P transaction) for the following sites of care:

• Physician office (Place of Service Code 11)
• Home (Place of Service Code 12)

Facility UB04 claim form (or electronically via an 837I transaction):

• Outpatient facility (Type of Bill 013x)

Important reminder

You must get authorization prior to administering these medications. Use the Novologix^® online web tool to quickly submit your requests.

Posted: December 2018
Line of business: Blue Care Network