7 commercial payer policies list J0475. 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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7 policies from 6 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 J0475 |
|---|---|---|
| Baclofen Pump | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Durable Medical Equipment - Baclofen Pump | 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 J0475 |
|---|---|---|
| Spasticity Management | Jun 21, 2023 | Covered |
| Policy | Effective | Status of J0475 |
|---|---|---|
| OZOBAX (BACLOFEN) SOLUTION | 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 J0475 |
|---|---|---|
| Baclofen (Fleqsuvy, Gablofen, Lioresal, Lyvispah, Ozobax/Ozobax DS); CP.PHAR.149 | 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 J0475 |
|---|---|---|
| Fleqsuvy (baclofen oral suspension) (PG112, 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 J0475 |
|---|---|---|
| Baclofen (Ozobax) Oral Solution | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |