Empire BlueCross BlueShield expands specialty pharmacy precertification list – effective 11/1/2022

Effective for dates of service on and after November 1, 2022, the specialty Medicare part B drugs 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
C9098	Carvykti (ciltacabtagene autoleucel)
J3490	Carvykti (ciltacabtagene autoleucel)
J3590	Carvykti (ciltacabtagene autoleucel)

 

If you have questions about this communication or need assistance with any other item, visit the Contact Us section at the bottom of our provider website for up-to-date contact information or call Provider Services via the number on the back of members’ ID cards.

 

NYBCBS-CR-004065-22 July 2022