Does Q2057 require prior authorization?

Yes, Q2057 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for Q2057?

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

Backwork Sign up free

`Q2057`, Afamitresgene autoleucel, including leukapheresis and dose preparation

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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.

Key Coverage Criteria

Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Oncology medications are medically necessary if (a) the drug is FDA-approved for the oncologic indication and used per FDA labeling, OR (b) the drug has an NCCN Category 1/2A/2B indication per NCCN Guidelines or NCCN Compendium.
Oncology medications may be considered medically necessary when the drug (a) is FDA-approved for an oncologic indication and used per FDA labeling, or (b) has NCCN Category 1/2A/2B recommendation per NCCN Guidelines or NCCN Compendium.

20 Active Policies

ARKBLUE-AFAMITRESGENE-AUTOLEUCEL-E-G-TECELRA-BCBCD91D3E, Afamitresgene autoleucel (e.g., Tecelra)

FLORIDA_BLUE-FLBLUE-TECELRA-AFAMITRESGENE-AUTOLEUCEL-F6B496C4AA, Tecelra (afamitresgene autoleucel)

BCBSLA-00911-450900B08D, 00911 afamitresgene autoleucel (Tecelra)

MGBHP-TECELRA-BF263270A1, Tecelra

BCBSM-2191171-082D39F1A1, TECELRA (AFAMITRESGENE AUTOLEUCEL)

BCBSMS-L-5-01-620-3C0E421B92, Tecelra (afamitresgene autoleucel)

BCBSMS-S-5-01-620-9F50DCD6F9, State and School Employees' Health Insurance Plan - Tecelra (afamitresgene autoleucel)

POINT32HEALTH-MDMNG-14026, Tecelra (afamitresgene autoleucel)

MULTI

HEALTHPARTNERS-CC-ENTRY-279799, Afamitresgene autoleucel (Tecelra)

MULTI

POINT32HEALTH-MDMNG-14036, Tecelra (afamitresgene autoleucel)

MULTI

MODA-MODA-MPS-TECELRA-A00B3EE68E, Tecelra (afamitresgene autoleucel)

HEALTHNET_OR-HNOR-AFAMITRESGENE-AUTOLEUCEL-TECELRA-CP-PHAR-678-44CDB99FDC, Afamitresgene Autoleucel (Tecelra); CP.PHAR.678

IBX-COMMERCIAL-08-02-32A-ED220DFF56, Afamitresgene autoleucel (Tecelra)

BCBSOK-RX502.061, Oncology Medications

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

AMERIHEALTH-COMMERCIAL-08-02-32A-FC4FBDC079, Afamitresgene autoleucel (Tecelra)

BCBSTN-fe704955e7, Afamitresgene Autoleucel (Tecelra)

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

BCBSNM-RX502.061, Oncology Medications

`Q2057`, Afamitresgene autoleucel, including leukapheresis and dose preparation

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

Q2057, Afamitresgene autoleucel, including leukapheresis and dose preparation

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`Q2057`, Afamitresgene autoleucel, including leukapheresis and dose preparation