23 commercial payer policies list J1203. 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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23 policies from 15 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 J1203 |
|---|---|---|
| Pombiliti (cipaglucosidase alfa-atga) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Pombiliti (cipaglucosidase alfa-atga)Effective 02/01/2024 - 06/30/2024 | Feb 1, 2024 | Prior auth requiredInferred from policy title |
| Pombiliti (cipaglucosidase alfa-atga)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. |
|---|
| Pombiliti (cipaglucosidase alfa-atga)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 J1203 |
|---|---|---|
| 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 J1203 |
|---|---|---|
| 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 J1203 |
|---|---|---|
| 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 J1203 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Cipaglucosidase alfa-atga (e.g., 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 J1203 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Cipaglucosidase Alfa-atga (Pombiliti) | Mar 1, 2024 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1203 |
|---|---|---|
| Cipaglucosidase Alfa-atga + Miglustat (Pombiliti + Opfolda); CP.PHAR.567 | 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 J1203 |
|---|---|---|
| Pombiliti (cipaglucosidase alfa-atga) | 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 J1203 |
|---|---|---|
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |