Policy library / J0641 Commercial payer policies listing J0641 10 policies from 10 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.
Arkansas Blue Cross and Blue Shield policies listing J0641, with the code’s status in each Policy Effective Status of J0641 Levoleucovorin Calcium (e.g., Khapzory) PayerPolicy · ARKBLUE-LEVOLEUCOVORIN-CALCIUM-E-G-KHAPZORY Not recorded Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
BCBS Illinois policies listing J0641, with the code’s status in each Policy Effective Status of J0641 Oncology Medications