35 commercial payer policies list J0221. 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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35 policies from 17 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 J0221 |
|---|---|---|
| Alglucosidase Alfa (Lumizyme)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. |
| Alglucosidase Alfa (Lumizyme)Effective 07/01/2022 - 06/30/2023 | Jul 1, 2022 | Prior auth requiredInferred from policy title |
| Alglucosidase Alfa (Lumizyme)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. |
|---|
| Alglucosidase Alfa (Lumizyme)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. |
|---|
| Alglucosidase Alfa (Lumizyme)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. |
|---|
| Alglucosidase Alfa (Lumizyme)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. |
|---|
| Lumizyme (alglucosidase alfa) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Lumizyme (alglucosidase alfa)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. |
|---|
| Lumizyme (alglucosidase alfa)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 J0221 |
|---|---|---|
| Alglucosidase alfa (e.g., Lumizyme), Avalglucosidase alfa-ngpt (Nexviazyme ), Cipaglucosidase alfa-atga (Pombiliti ) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alglucosidase alfa (e.g., Lumizyme), Avalglucosidase alfa-ngpt (Nexviazyme ), Cipaglucosidase alfa-atga (Pombiliti ) | 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 J0221 |
|---|---|---|
| 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 J0221 |
|---|---|---|
| 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 J0221 |
|---|---|---|
| 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 J0221 |
|---|---|---|
| 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 J0221 |
|---|---|---|
| Alglucosidase Alfa Lumizyme | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alglucosidase Alfa Lumizyme 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 J0221 |
|---|---|---|
| Pompe disease enzyme replacement therapy: alglucosidase alfa (Lumizyme), avalglucosidase alfa-ngpt (Nexviazyme), cipaglucosidase alfa-atga (Pombiliti) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Pompe disease enzyme replacement therapy: alglucosidase alfa (Lumizyme), avalglucosidase alfa-ngpt (Nexviazyme), cipaglucosidase alfa-atga (Pombiliti) - 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 J0221 |
|---|---|---|
| Alglucosidase alfa (e.g., Lumizyme), Avalglucosidase alfa-ngpt (Nexviazyme ), Cipaglucosidase alfa-atga (Pombiliti ) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Alglucosidase alfa (e.g., Lumizyme), Avalglucosidase alfa-ngpt (Nexviazyme ), Cipaglucosidase alfa-atga (Pombiliti ) | 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 J0221 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | May 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J0221 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | May 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J0221 |
|---|---|---|
| Alglucosidase alfa (e.g., Lumizyme) | 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 J0221 |
|---|---|---|
| Alglucosidase Alfa (Lumizyme) | Jan 13, 2007 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J0221 |
|---|---|---|
| Alglucosidase alfa (Lumizyme); CP.PHAR.160 | 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 J0221 |
|---|---|---|
| Pompe Disease Treatment with Lumizyme (Alglucosidase alfa) | 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 J0221 |
|---|---|---|
| Lumizyme (alglucosidase alfa) | 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 J0221 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | May 1, 2026 | Covered |