Ilaris® (canakinumab)

Authorization forms

Traditional & Optimized (11/2018)

Medicaid (05/2018)

Medicare Part D (11/2018)

No prior authorization required if billed under Medicare Part B

No prior authorization required for:

  • Emergency room
  • Inpatient
  • 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.

Code(s): J0638

Benefit: Medical

Notes:

  • Treatment of Familial Cold Autoinflammatory Syndrome (FCAS) and Muckle-Wells Syndrome (MWS)
  • C-code billable by facility only