Effective for dates of service on and after July 1, 2019, the following specialty pharmacy codes from the current guideline will be included in our prior authoirzation review process.

 

Please note, inclusion of NDC code on your claim will shorten the claim processing time of drugs billed with a Not Otherwise Classified (NOC) code.

 

Empire’s prior authorization clinical review of these specialty pharmacy drugs will be managed by AIM Specialty Health® (AIM), a separate company.

 

The following clinical guideline will be effective July 1, 2019.

 

Clinical Guideline

HCPCS or CPT Code(s)

NDC Code(s)

Drug

CG-THER-RAD-03

A9699, C9408

71258-0015-02 71258-0015-22

Azedra®



Featured In:
April 2019 Empire Provider Newsletter