No prior authorization required for Medicare
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.
Treatment of urothelial cancer
See PA form for criteria for Commercial and Medicaid
PA for Medicare
This drug may be covered under Medicare Part B or D depending upon the circumstances. Information may need to be submitted describing the use and setting of the drug to make the determination.
Refer to CMS local coverage determination criteria for Part B when available.