Policy Updates Prior AuthorizationMedicaidMay 31, 2023

Cimerli Medical Prior Authorization update

Prior authorization updates for medications billed under the medical benefit

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

CC-0072

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