New York
Provider Communications
Empire expands specialty pharmacy precertification list
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.
Featured In:
August 2022 Newsletter
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) |
Featured In:
August 2022 Newsletter