Effective for dates of service on and after September 1, 2022, the specialty Medicare Part B drugs listed in the table below will be included in our precertification review process.


Federal and state law, as well as state contract language and Centers for Medicare & Medicaid Services guidelines, including definitions and specific contract provisions and exclusions, take precedence over these precertification rules and must be considered first when determining coverage. Noncompliance with new requirements may result in denied claims.


HCPCS or CPT® codes

Medicare Part B drugs

C9399, J3490, J3590, J9999

Kimmtrak (tebentafusp-tebn)

C9399, J3490, J3590, J9999

Enjaymo (sutimlimab-jome)

C9399, J3590

Tezspire (tezepelumab-ekko)

J3490, J3590

Vabysmo (faricimab-svoa)

EBCCARE-0821-22 May 2022

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August 2022 Newsletter