Qutenza® (capsaicin 8% patch)

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): J7335

Benefit: Medical

Notes:

Diagnosis of post-herpetic neuralgia

Prior use of all of the following:

  • Gabapentin
  • Lyrica (requires step therapy with gabapentin)
  • Generic tricyclic antidepressant (TCA)
  • oxycodone CR or morphine CR Lidoderm Patch (requires prior authorization)