Effective for dates of service on and after April 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.

Federal and state law, as well as state contract language and CMS guidelines, including definitions and specific contract provisions/exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.

HCPCS or CPT® code

Medicare Part B drugs

J3490, J3590

Saphnelo

J3490, J3590

Ryplazim

J3590

Rylaze


ACADPEC-774-21



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January 2022 Anthem Blue Cross Provider News - California