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HCPCS/CPT Q5169, Injection, pegfilgrastim-unne (armlupeg), biosimilar, 0.5 mg | Prior Auth Required

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`Q5169`, Injection, pegfilgrastim-unne (armlupeg), biosimilar, 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

2 Active Policies

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5

, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

Related Codes

C9399(2 policies)J0870(2 policies)J0209(2 policies)J0584(2 policies)J0208(2 policies)J0641(2 policies)J0642(2 policies)J0881(2 policies)

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