15 commercial payer policies list J0597. 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.
Free account. Policy pages stay open to everyone.
15 policies from 8 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 J0597 |
|---|---|---|
| Berinert (C1 esterase inhibitor [human]) | Jan 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Berinert (C1 esterase inhibitor [human])Effective 02/01/2024 - 11/30/2024 | Feb 1, 2024 | Prior auth requiredInferred from policy title |
| Berinert (C1 esterase inhibitor [human])Effective 12/01/2024 - 12/31/2025 | Dec 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| C1 Esterase Inhibitor (Berinert)Effective 01/01/2019 - 05/31/2019 | Jan 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| C1 Esterase Inhibitor (Berinert)Effective 03/01/2022 - 02/28/2023 | Mar 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| C1 Esterase Inhibitor (Berinert)Effective 03/01/2023 - 01/31/2024 | Mar 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| C1 Esterase Inhibitor (Berinert)Effective 05/01/2020 - 03/01/2021 | May 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| C1 Esterase Inhibitor (Berinert)Effective 06/01/2019 - 05/31/2020 | Jun 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J0597 |
|---|---|---|
| C1 Esterase Inhibitors (Berinert, Cinryze, Haegarda, Ruconest); CP.PHAR.202 | 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 J0597 |
|---|---|---|
| Drug Therapy for Hereditary Angioedema [Cinryze, Berinert, Haegarda (Human C1 Inhibitor), Kalbitor (Ecallantide), Firazyr (Icatibant), Ruconest (C1 Esterase Inhibitor [Recombinant]), Takhzyro (lanadelumab-flyo)] | 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 J0597 |
|---|---|---|
| 00276 C1 Esterase Inhibitor (Berinert) | 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 J0597 |
|---|---|---|
| Berinert (C1 Esterase Inhibitor, Human) | 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 J0597 |
|---|---|---|
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | Nov 1, 2025 | Covered |
| Policy | Effective | Status of J0597 |
|---|---|---|
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | Nov 1, 2025 | Covered |
| Policy | Effective | Status of J0597 |
|---|---|---|
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | Nov 1, 2025 | Covered |