Chimeric antigen receptor T-cell therapy requires prior authorization for all places of service
Chimeric antigen receptor T-cell (CAR T) therapy, including immunotherapy and all inpatient stays, will continue to require a prior authorization (PA) regardless of the place of service in which it is given.
CAR T codes require PA, and all requests must be reviewed by Empire BlueCross BlueShield HealthPlus for PA regardless of place of service or if billed with an unlisted code.
Please refer to the Precertification Lookup Tool for detailed PA requirements by visiting http://www.empireblue.com/nymedicaiddoc and choosing Precertification Lookup Tool from the Precertification & Claims menu.
CAR T therapy is currently represented by the following codes:
- Q2040 — Tisagenlecleucel (brand name: Kymriah™), up to 250 million CAR-positive viable T-cells, including leukapheresis and dose-preparation procedures, per infusion.
- Q2041 — Axicabtagene Ciloleucel, up to 200 million autologous anti-CD19 CAR T-cells, including leukapheresis and dose-preparation procedures, per infusion (new code effective April 1, 2018).
CAR T therapy in any form will continue to require PA. Please use one of the following methods to submit a request:
- Web: www.availity.com
- Fax: 1-800-964-3627
Noncompliance with these requirements may result in denied claims. Federal and state law, as well as state contract language including definitions, and specific contract provisions and exclusions, take precedence over these PA rules and must be considered first when determining coverage.
If you have questions about this communication or need assistance with any other item, contact your local Provider Relations representative or call Provider Services at 1-800-450-8753.
June 2018 Empire Provider Newsletter