These services require Pre-Authorization. | Click to View Medical Policy | J-Codes |
Actemra (Tocilizumab) |
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J3262
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Acthar |
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J0800
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Actimmune |
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J1830, J9216
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Adagen |
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J2504
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Adakveo |
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J0791
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Adcetris |
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J9042
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Adcirca |
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Adempas |
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Advate |
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J7192
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Adynovate (Pegylated Antihemophilic Factor) |
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J7207
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Aimovig |
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Aldurazyme |
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J1931
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Alecensa (Alectinib) |
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Alferon N |
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J9215
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Aliqopa |
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J9057
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Alpha 1 - Antitrypsin Inhibitor Therapy |
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Alphanate |
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J7186
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AlphaNine SD |
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J7193
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Alprostadil |
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J0270
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Alunbrig (Brigatinib) |
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Amitiza |
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Ampyra |
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Androgel 1.62% (Testosterone Gel) |
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Antihemohilic Factor, Generic |
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J7182
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Aralast |
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J0256
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Asparlas |
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J9118
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Astagraf XL |
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Aubagio |
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Avastin |
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J9035
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Axiron |
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Azelex Cream |
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Bavencio (Avelumab) |
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Bebulin VH |
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J7194
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Beleodaq |
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Benefix |
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J7195
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Benicar/Benicar HCT |
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Benlysta (Belimumab) |
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J0490
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Bivigam |
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J1599
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Blincyto |
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C9449
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Boniva |
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Botox (Inj.: Botulinum Toxin Type A, per unit) |
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J0585
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Braftovi |
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Carimune NF |
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J1566
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Caverject |
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J0270
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Ceredase |
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J0205
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Cerezyme |
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J1785
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Chantix (Varenicline) |
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Cialis |
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Cimzia |
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J0718
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Cladribine |
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J9065
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Coagadex (Coagulation Factor X (Human)) |
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J7175
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Corifact |
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J7180
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Cresemba |
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C9456
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crysvita |
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J0584
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Cuvitru (Immune Globulin) |
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Cyramza |
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C9025
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Cystagon (Cysteamine) |
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Cytogam (Cytomegalovirus Immune Globulin (CMV-IGIV)) |
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J0850
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Darzalex (Daratumumab) |
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J9145
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Daytrana |
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J0718
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Dextenza |
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C9048
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Diclofenac Gel 3% |
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Differin Cream/Gel |
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Diovan/Diovan HCT (Valsartan & Valsarta/HCTZ) |
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Dysport |
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J0586
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Edarbi/Edarbyclor (Azilsartan & Azilsatan/Chlorthalidone) |
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Edex |
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J0270
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Elaprase |
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J1743
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Elelyso |
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J3060
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Elzonris |
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C9049
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Emcyt (Estramustine) |
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Emgality |
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Empliciti (Elotuzumab) |
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J9176
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Enablex (Darifenacin) |
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Enhertu |
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J9358
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Entyvio |
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J3380
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Epclusa (Sofosbuvir/Velpatasvir) |
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Erbitux |
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J9055
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Erwinaze |
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J9019
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Esbriet (Pirfenidone) |
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Eylea |
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J0178
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Fabrazyme |
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J0180
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Factor Products for Bleeding Disorders |
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Farxiga |
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Farydak |
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Fentora |
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Firazyr (Icatibant) |
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J1744
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Flebogamma |
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J1567
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Flolan |
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J1325
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Flolan Diluent |
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S0155
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Gammagard |
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J1566
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Gammaked |
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J1561
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Gammaplex |
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J1557
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Gammaplex NOS |
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J1599
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Gamunex |
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J1561
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Gazyva |
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Genotropin |
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J2941
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Gesterone |
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J2675
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Gestrin |
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J2675
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