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.
Code(s): J3490, C9399
Benefit: Pharmacy only, must be ordered from a specialty pharmacy
Notes: Treatment of homozygous familial hypercholesterolemia