Does J0223 require prior authorization?

Yes, J0223 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J0223?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J0223`, Injection, givosiran, 0.5 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation: Prior authorization is required by HealthPartners Pharmacy Administration; claims must be billed as medical claims.

Key Coverage Criteria

Initial therapy with Givlaari is medically necessary for adults with acute hepatic porphyria (AHP) when: diagnosis of AHP is established; and the patient has active disease defined by at least 2 porphyria attacks in the past 6 months, OR patient is on prophylactic hemin with documented baseline hemin requirements and attack history; and patient has not had a liver transplant; and patient will not receive concomitant prophylactic hemin while on Givlaari; and treatment is prescribed by or in consu [...]
Initial prior authorization is valid for 6 months (180 days).
Patient is at least 18 years of age.

20 Active Policies

ARKBLUE-GIVOSIRAN-E-G-GIVLAARI-06E05E03E6, Givosiran (e.g., GIVLAARI)

FLORIDA_BLUE-FLBLUE-GIVOSIRAN-GIVLAARI-F6D8EF8173, Givosiran (Givlaari)

BCBSLA-00705-08503EE78F, 00705 givosiran (Givlaari)

BCBSM-2120716-2C2D8DD27C, GIVLAARI (GIVOSIRAN)

BCBSMS-S-5-01-553-228C2429C5, State and School Employees' Health Insurance Plan - Givlaari (givosiran)

BCBSMS-L-5-01-553-EF6BCF8E82, Givlaari (givosiran)

HEALTHPARTNERS-CC-ENTRY-226837, Givosiran (Givlaari) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-12881, Givlaari (givosiran)

MULTI

HEALTHPARTNERS-CC-ENTRY-226973, Givosiran (Givlaari)

MULTI

POINT32HEALTH-MDMNG-12891, Givlaari (givosiran)

MULTI

BCBSND-GIVOSIRAN-GIVLAARI-F88F07569B, Givosiran Givlaari

BCBSNJ-DRUGS-199-9AB4C22BE2, Givosiran (Givlaari)

HEALTHNET_OR-HNOR-GIVOSIRAN-GIVLAARI-CP-PHAR-457-447650DC8A, Givosiran (Givlaari); CP.PHAR.457

MODA-GIVLAARI-FCB14CDE89, Givlaari (givosiran)

IBX-MEDICARE-ADVANTAGE-MA08-112A-7946670779, Givosiran (Givlaari) and Panhematin (Hemin)

IBX-COMMERCIAL-08-00-21A-92E927E276, Givosiran (Givlaari) and Panhematin (Hemin)

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-CVHVNFE0X027ROU3QQ0DNW-1F45E18088, Givlaari

UHC-COMM-MD-GIVLAARI-GIVOSIRAN-COMMUNITY-PLAN-MEDICA-6AF0BB0232, Givlaari (Givosiran) – Community Plan Medical Benefit Drug Policy

UHC-POL-givlaari-givosiran, Givlaari (Givosiran)

UHC-EXCH-MD-GIVLAARI-GIVOSIRAN-COMMERCIAL-AND-INDIVI-34537A317B, Givlaari (Givosiran) – Commercial and Individual Exchange Medical Benefit Drug Policy

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J0223, Injection, givosiran, 0.5 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation: Prior authorization is required by HealthPartners Pharmacy Administration; claims must be billed as medical claims.

Key Coverage Criteria

Initial therapy with Givlaari is medically necessary for adults with acute hepatic porphyria (AHP) when: diagnosis of AHP is established; and the patient has active disease defined by at least 2 porphyria attacks in the past 6 months, OR patient is on prophylactic hemin with documented baseline hemin requirements and attack history; and patient has not had a liver transplant; and patient will not receive concomitant prophylactic hemin while on Givlaari; and treatment is prescribed by or in consu [...]
Initial prior authorization is valid for 6 months (180 days).
Patient is at least 18 years of age.

20 Active Policies

ARKBLUE-GIVOSIRAN-E-G-GIVLAARI-06E05E03E6, Givosiran (e.g., GIVLAARI)

FLORIDA_BLUE-FLBLUE-GIVOSIRAN-GIVLAARI-F6D8EF8173, Givosiran (Givlaari)

BCBSLA-00705-08503EE78F, 00705 givosiran (Givlaari)

BCBSM-2120716-2C2D8DD27C, GIVLAARI (GIVOSIRAN)

BCBSMS-S-5-01-553-228C2429C5, State and School Employees' Health Insurance Plan - Givlaari (givosiran)

BCBSMS-L-5-01-553-EF6BCF8E82, Givlaari (givosiran)

HEALTHPARTNERS-CC-ENTRY-226837, Givosiran (Givlaari) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-12881, Givlaari (givosiran)

MULTI

HEALTHPARTNERS-CC-ENTRY-226973, Givosiran (Givlaari)

MULTI

POINT32HEALTH-MDMNG-12891, Givlaari (givosiran)

MULTI

BCBSND-GIVOSIRAN-GIVLAARI-F88F07569B, Givosiran Givlaari

BCBSNJ-DRUGS-199-9AB4C22BE2, Givosiran (Givlaari)

HEALTHNET_OR-HNOR-GIVOSIRAN-GIVLAARI-CP-PHAR-457-447650DC8A, Givosiran (Givlaari); CP.PHAR.457

MODA-GIVLAARI-FCB14CDE89, Givlaari (givosiran)

IBX-MEDICARE-ADVANTAGE-MA08-112A-7946670779, Givosiran (Givlaari) and Panhematin (Hemin)

IBX-COMMERCIAL-08-00-21A-92E927E276, Givosiran (Givlaari) and Panhematin (Hemin)

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-CVHVNFE0X027ROU3QQ0DNW-1F45E18088, Givlaari

UHC-COMM-MD-GIVLAARI-GIVOSIRAN-COMMUNITY-PLAN-MEDICA-6AF0BB0232, Givlaari (Givosiran) – Community Plan Medical Benefit Drug Policy

UHC-POL-givlaari-givosiran, Givlaari (Givosiran)

UHC-EXCH-MD-GIVLAARI-GIVOSIRAN-COMMERCIAL-AND-INDIVI-34537A317B, Givlaari (Givosiran) – Commercial and Individual Exchange Medical Benefit Drug Policy

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Ask Backwork about J0223 Sign up free

`J0223`, Injection, givosiran, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J0223`, Injection, givosiran, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J0223, Injection, givosiran, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J0223, Injection, givosiran, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J0223`, Injection, givosiran, 0.5 mg

`J0223`, Injection, givosiran, 0.5 mg