Ruconest® (recombinant c1 esterase inhibitor)

Authorization form

 Medicare (09/2018)

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): J0596

Benefit: Pharmacy

Notes: Treatment of hereditary angioedema