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Medical Policy Revision: Melphalan (Alkeran and Evomela)

Effective April 19, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain professional claims for injectable chemotherapy drugs Alkeran® and Evomela®.

We encourage you to visit our Medical Policy Manual to review the guidelines of our Melphalan (Alkeran and Evomela) medical policy which identify when the use of these injectable drugs is considered medically necessary.

Based on the guidelines of our medical policy, Melphalan (Alkeran and Evomela), AND the submitted diagnosis code(s), claims for services provided on and after April 19, 2018 will be processed as noted below.

  • Claims that include HCPCS code J9245 may pend while information to help us determine if the drug in question is considered medically necessary is requested and reviewed.
  • HCPCS code J9245 included on claims may be denied as a service that is “not related” to the submitted diagnosis code(s).

Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after April 19, 2018.

CPT® is a registered mark of the American Medical Association.

Evomela® is a registered trademark of Spectrum Pharmaceuticals, Inc.

Alkeran® is a registered trademark of GlaxoSmithKline plc.

Published on: January 18, 2018, 09:22 a.m. ET
Last updated on: November 25, 2020, 00:55 a.m. ET