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): J2860, C9455
Notes: Treatment of multicentric Castleman's disease (MCD) who are HIV & human herpesvirus-8 (HHV-8) negative.