MedicaidMay 31, 2023
Cimerli Medical Prior Authorization update
The original message was posted for a July 1, 2023, effective date. This was in error and the new prior authorization will not take effect until September 1, 2023.
Effective for dates of service on and after September 1, 2023, the following medication codes from current or new Clinical Criteria documents billed on medical claims require prior authorization.
Please note, inclusion of a national drug code on your medical claim is necessary for claims processing.
Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.
Clinical Criteria | HCPCS or CPT® code(s) | Drug name |
Q5128 | Cimerli (ranibizumab-cqrn) |
What if I need assistance?
If you have questions about this communication or need assistance with any other item, contact your local Provider Relationship Management representative or call Provider Services at the following numbers:
- 800-407-4627 (outside L.A. County)
- 888-285-7801 (inside L.A. County)
Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.
CABC-CD-020176-23-CPN19824
PUBLICATIONS: July 2023 Provider Newsletter
To view this article online:
Visit https://providernews.anthem.com/california/articles/cimerli-medical-prior-authorization-update-13638
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