Products & Programs PharmacyAnthem Blue Cross and Blue Shield | Medicare AdvantageJune 26, 2023

Medicare Part B precert expansion may Mmltiple drug alignment

AMH Health, LLC expands specialty pharmacy precertification list

Effective for dates of service on and after October 1, 2023, the specialty Medicare Part B drug 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® codes

Medicare Part B drugs

J1931

Aldurazyme (laronidase)

J0256

Aralast NP (alpha-1 proteinase inhibitor), 

Prolastin-C (alpha-1 proteinase inhibitor), 

Zemaira (alpha-1 proteinase inhibitor)

J1786

Cerezyme (imiglucerase)

J0584

Crysvita (burosumab-twza)

J1743

Elaprase (idursulfase)

J3060

Elelyso (taliglucerase)

J0180

Fabrazyme (agalsidase beta)

J0257

Glassia (alpha-1 proteinase inhibitor)

J0638

Ilaris (canakinumab)

J0221

Lumizyme (alglucosidase alfa)

J3397

Mepsevii (vestronidase alfa)

J1458

Naglazyme (galsulfase)

J0219

Nexviazyme (avalglucosidase alfa-ngpt)

J0222

Onpattro (patisiran)

J1322

Vimizim (elosulfase alfa)

J3385

Vpriv (velaglucerase)

J0775

Xiaflex (collagenase clostridium histolyticum)

MEAMH-CR-026022-23-CPN25545

PUBLICATIONS: July 2023 Provider Newsletter