(plasma-derived C1 esterase inhibitor)
Traditional & Optimized: Cinryze is not covered.
Medicaid: This is a carve-out. Contact fee-for-service Medicaid for coverage.
No prior authorization required for:
- Emergency room
- Skilled nursing facility
Injectable auth/billing notes:
Medications billed with miscellaneous codes will be reviewed. Explanatory notes must accompany the claim.
Priority Health Medicare applies CMS local coverage determination criteria when available for Part B drugs.
Notes: Per 10 u; treatment of C1 esterase inhibitor [C1-INH] deficiency