24 commercial payer policies list J1290. 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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24 policies from 12 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 J1290 |
|---|---|---|
| Ecallantide (Kalbitor)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. |
| Ecallantide (Kalbitor)Effective 03/01/2022 - 02/28/2023 | Mar 1, 2022 | Prior auth requiredInferred from policy title |
| Ecallantide (Kalbitor)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. |
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| Ecallantide (Kalbitor)Effective 04/01/2021 - 02/28/2022 | Apr 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Ecallantide (Kalbitor)Effective 05/01/2020 - 03/31/2021 | May 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Ecallantide (Kalbitor)Effective 06/01/2019 - 04/30/2020 | Jun 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Kalbitor (ecallantide) | Jan 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Kalbitor (ecallantide)Effective 02/01/2024 - 11/30/2024 | Feb 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Kalbitor (ecallantide)Effective 12/01/2024 - 12/26/2024 | Dec 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
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| Policy | Effective | Status of J1290 |
|---|---|---|
| Management of Hereditary Angioedema (HAE) with C1 Esterase Inhibitor, Human and Ecallantide | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1290 |
|---|---|---|
| Management of Hereditary Angioedema (HAE) with C1 Esterase Inhibitor, Human and Ecallantide | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1290 |
|---|---|---|
| Management of Hereditary Angioedema (HAE) with C1 Esterase Inhibitor, Human and Ecallantide | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1290 |
|---|---|---|
| Management of Hereditary Angioedema (HAE) with C1 Esterase Inhibitor, Human and Ecallantide | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1290 |
|---|---|---|
| Ecallantide (Kalbitor); CP.PHAR.177 | 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 J1290 |
|---|---|---|
| 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 J1290 |
|---|---|---|
| 00294 ecallantide (Kalbitor) | 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 J1290 |
|---|---|---|
| Kalbitor (ecallantide) | 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 J1290 |
|---|---|---|
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | Nov 1, 2025 | Covered |
| Policy | Effective | Status of J1290 |
|---|---|---|
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | Nov 1, 2025 | Covered |
| Policy | Effective | Status of J1290 |
|---|---|---|
| Hereditary Angioedema (HAE), Treatment and Prophylaxis | Nov 1, 2025 | Covered |