Kadcyla (ado-trastuzumab emtansine)

Authorization forms

Traditional, Optimized. & Medicaid (05/2019)

Medicare Part D (05/2019)

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): J9354

Benefit: Medical

Notes: Treatment of metastatic breast cancer