The Codes Requiring Service Authorization spreadsheet has been updated. The following drugs will re

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The Codes Requiring Service Authorization spreadsheet has been updated. The following drugs will require SA effective May 1, 2024.

Alyglo™ (immune globulin, human-stwk) J1599 Injection, immune globulin, intravenous, non-lyophilized (e.g., liquid), not otherwise specified, 500 mg
Asceniv™ (immune globulin(human)-slra) J1554 Injection, immune globulin (asceniv), 500 mg
Cutaquig® (immune globulin(human)-hipp) J1551 Injection, immune globulin (cutaquig), 100 mg
Cuvitru (immune globulin (human)) J1555 Injection, immune globulin (cuvitru), 100 mg
Gammaplex® (immune globulin(human)) J1557 Injection, immune globulin, (gammaplex), intravenous, non-lyophilized (e.g., liquid), 500 mg
Panzyga® (immune globulin (human)ifas) J1576 Injection, immune globulin (panzyga), intravenous, non-lyophilized (e.g., liquid), 500 mg
Xembify® (immune globulin (human)-klhw) J1558 Injection, immune globulin (xembify), 100 mg

Date of Update

Tue, 04/09/2024 - 12:00

Update Category

Provider Type

Provider Year

2024