Velcade® (bortezomib)

Authorization forms

Traditional, Optimized & Medicaid (05/2019)

No prior authorization required for Medicare

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): J9041

Benefit: Medical

Notes: Treatment of Multiple Myeloma

Criteria for coverage:

  • See PA form for criteria for Commercial and Medicaid

  • No PA for Medicare