Codes Requiring Service Authorization spreadsheet has been updated The following drugs have been add

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Codes Requiring Service Authorization spreadsheet has been updated

The following drugs have been added and will require service authorization for dates of service on or after April 1, 2024.

Drug Name HCPCS Code HCPCS Description

Adzynma (apadamtase alfa) C9167 Injection, apadamtase alfa, 10 units
Cosentyx® (secukinumab) C9166 Injection, secukinumab, intravenous, 1 mg
Eyelea® HD (aflibercept) J0177 Injection, afibercept hd, 1 mg
Izervay™ (avacincaptad pegol) J2782 Injection, avacincaptad pegol, 0.1 mg
Omvoh™ (mirikizumab-mrkz) C9168 Injection, mirikizumab-mrkz, 1 mg
Pombiliti™ (cipaglucosidase alfa-atga) J1203 Injection, cipaglucosidase alfa-atga, 5 mg
Syfovre™ (pegcetacoplan) J2781 Injection, pegcetacoplan, intravitreal, 1 mg
Tofidence™ (tocilizumab-bavi) Q5133 Injection, tocilizumab-bavi (tofidence), biosimilar, 1 mg
Tyruko® (natalizumab-sztn) Q5144 Injection, natalizumab-sztn (tyruko), biosimilar, 1 mg
Veopoz™ (pozelimab-bbfg) J9376 Injection, pozelimab-bbfg, 1 mg

Date of Update

Thu, 03/14/2024 - 12:00

Update Category

Program Updates

Billing/Claims/Reimbursement

Provider Type

All providers

Pharmacy

Hospitals

Provider Year

2024