Zevalin® (ibritumomab tiuxetan)
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.
Radioimmunotherapy; indicated for the treatment of relapsed or refractory low-grade, follicular, or transformed B-cell non-Hodgkin's lymphoma (NHL)
See PA form for criteria for Commercial and Medicaid
Refer to CMS local coverage determination criteria for Part B when available.