36 commercial payer policies list J0180. 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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36 policies from 18 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 J0180 |
|---|---|---|
| Agalsidase Beta (Fabrazyme)Effective 01/01/2019 - 09/30/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Agalsidase Beta (Fabrazyme)Effective 07/01/2022 - 06/30/2023 | Jul 1, 2022 | Prior auth requiredInferred from policy title |
| Agalsidase Beta (Fabrazyme)Effective 07/01/2023 - 06/30/2024 | Jul 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Agalsidase Beta (Fabrazyme)Effective 08/01/2021 - 06/30/2022 | Aug 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Agalsidase Beta (Fabrazyme)Effective 09/01/2020 - 07/31/2021 | Sep 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Agalsidase Beta (Fabrazyme)Effective 10/01/2019 - 08/30/2020 | Oct 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Fabrazyme (agalsidase beta) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Fabrazyme (agalsidase beta)Effective 07/01/2024 - 06/30/2025 | Jul 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Fabrazyme (agalsidase beta)Effective 07/01/2025 - 06/30/2026 | Jul 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J0180 |
|---|---|---|
| Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | 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 J0180 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Agalsidase Beta Fabrazyme | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Agalsidase Beta Fabrazyme ME | 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 J0180 |
|---|---|---|
| Fabry disease enzyme replacement therapy: agalsidase agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) – 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. |
| Fabry disease enzyme replacement therapy: agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | 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 J0180 |
|---|---|---|
| Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Agalsidase beta (Fabrazyme) and pegunigalsidase alfa-iwxj (Elfabrio) | 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 J0180 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Enzyme Replacement Therapy (ERT) for Fabry Disease: Agalsidase Beta (e.g., Fabrazyme) and Pegunigalsidase alfa (e.g., Elfabrio) | 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 J0180 |
|---|---|---|
| ENZYME REPLACEMENT THERAPY - AGALSIDASE: FABRAZYME (J0180) RETIRED AS OF 10/8/2020 | 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 J0180 |
|---|---|---|
| Agalsidase Beta(Fabrazyme) | Feb 1, 2005 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0180 |
|---|---|---|
| Agalsidase beta (Fabrazyme); CP.PHAR.158 | 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 J0180 |
|---|---|---|
| Agalsidase Beta (Fabrazyme) | 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 J0180 |
|---|---|---|
| Fabrazyme (agalsidase beta) | 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 J0180 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |