28 commercial payer policies list J0174. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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28 policies from 19 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (lecanemab-irmb) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Leqembi (lecanemab-irmb)Effective 05/01/2024 - 04/30/2025 | May 1, 2024 | Prior auth requiredInferred from policy title |
| Leqembi (lecanemab-irmb)Effective 05/01/2025 - 04/30/2026 | May 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Leqembi (lecanemab)Effective 06/01/2023 - 04/30/2024 | Jun 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J0174 |
|---|---|---|
| Lecanemab-irmb | Jun 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Lecanemab-irmb | Jun 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Lecanemab-irmb | Jun 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Lecanemab-irmb | Jun 15, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (lecanemab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Leqembi (lecanemab) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (Lecanemab-Irmb) | Apr 1, 2026 | Covered |
| Leqembi (Lecanemab-Irmb) – Individual Exchange Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Alzheimer's Disease Tests | Sep 8, 2023 | Covered |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Monoclonal Antibodies for Treatment of Alzheimer Disease [Aducanumab (e.g., Aduhelm) and Lecanemab (e.g., Leqembi)] | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| LEQEMBI | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| LEQEMBI (LECANEMAB) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Lecanemab-irmb (Leqembi) | May 2, 2023 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (lecanemab-irmb) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Lecanemab-irmb (Leqembi); CP.PHAR.596 | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Aducanumab (Aduhelm) and lecanemab (Leqembi and Leqembi Iqlik) – Minnesota Health Care Programs | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (lecanemab-irmb) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (lecanemab-irmb) (PG138, Ver. 5) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (Lecanemab-Irmb) | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J0174 |
|---|---|---|
| Leqembi (Lecanemab-Irmb) | Apr 1, 2026 | Covered |