Nevada
Provider Communications
Prior authorization updates for medications billed under the medical benefit
Effective for dates of service on and after January 1, 2022 the following medication codes billed on medical claims from current or new Clinical Criteria documents will require prior authorization.
Please note, the inclusion of a national drug code on your medical claim will help expedite claim processing of drugs billed with a not otherwise classified (NOC) code.
Visit the Clinical Criteria website to search for the specific Clinical Criteria listed below.
Clinical Criteria |
HCPCS or CPT® code(s) |
Drug |
ING-CC-0183 |
J3590 |
Sogroya |
ING-CC-0184 |
J9348 |
Danyelza |
ING-CC-0185 |
J0224 |
Oxlumo |
ING-CC-0186 |
J9353 |
Margenza |
ING-CC-0187 |
J3490, J3590, Q2054 |
Breyanzi |
ING-CC-0189 |
J3490, J3590, J1426 |
Amondys 45 |
ING-CC-0190 |
J3490, J3590, C9399 |
Nulibry |
If you have questions about this communication, call Provider Services at 844-396-2330.
Featured In:
December 2021 Anthem Provider News - Nevada