Policy Updates Prior AuthorizationHoosier Healthwise, Healthy Indiana Plan, Hoosier Care Connect, and IN PathWays for AgingJune 12, 2023

Cimerli Medical Prior Authorization update

Prior authorization updates for medications billed under the medical benefit

Effective for dates of service on and after August 1, 2023, the following medication codes billed on medical claims from current or new Clinical Criteria documents require prior authorization.

Please note, the 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 Network Relations consultant or call Provider Services at: 

  • Hoosier Healthwise: 866-408-6132 
  • Healthy Indiana Plan: 844-533-1995 
  • Hoosier Care Connect: 844-284-1798

Note: Prior authorization requests for certain medications may require additional documentation to determine medical necessity.

INBCBS-CD-020179-23-CPN19824

PUBLICATIONS: July 2023 Provider Newsletter