Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
7 active Medicare policies list J1745, and 58 commercial payer policies list it. 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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J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
National · Effective Aug 8, 2024
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
National · Effective Jan 1, 2026
J6 · Effective Apr 1, 2026
58 policies from 25 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.
Showing 10 of 11 · All EviCore by Evernorth policies
| Policy | Effective | Status of J1745 |
|---|---|---|
| Infliximab (Remicade, Inflectra, Renflexis, Avsola, Infliximab) Non-oncologyEffective 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. |
| Infliximab (Remicade, Inflectra, Renflexis, Avsola, Infliximab)_Non-oncEffective 09/01/2023 - 12/31/2023 | Sep 1, 2023 | Prior auth required |
| Infliximab (Remicade, Inflectra, Renflexis, Avsola, Infliximab)_Non-oncologyEffective 01/01/2024 - 11/30/2024 | Jan 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Infliximab (Remicade, Inflectra, Renflexis, Avsola)Effective 02/01/2021 - 04/30/2021 | Feb 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Infliximab (Remicade, Inflectra, Renflexis, Avsola)Effective 05/01/2021 - 04/30/2022 | May 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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| Infliximab (Remicade, Inflectra, Renflexis, Avsola)Effective 05/01/2022 - 10/31/2022 | May 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Infliximab (Remicade, Inflectra, Renflexis, Avsola)Effective 11/01/2022 - 08/31/2023 | Nov 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Infliximab (Remicade, Inflectra, Renflexis)Effective 10/01/2019 - 09/30/2020 | Oct 1, 2019 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Infliximab (Remicade, Inflectra, Renflexis)Effective 10/01/2020 - 01/31/2021 | Oct 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Infliximab (Remicade, Inflectra, Renflexis)Effective 11/02/2018 - 09/30/2019 | Nov 2, 2018 | 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 J1745 |
|---|---|---|
| 00217 Select infliximab Products | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| 00331 Measurement of Serum Antibodies to Infliximab and Adalimumab-Retired Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| 00539 infliximab-dyyb (Inflectra)-Retired Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| 00607 infliximab-abda (Renflexis)- Retired Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| 00712 infliximab-axxq (Avsola)- Retired Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| 00897 infliximab-dyyb (Zymfentra) | 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 J1745 |
|---|---|---|
| Alopecia Areata | Feb 16, 2024 | Covered |
| Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments | Feb 20, 2024 | Covered |
| Infliximab | Feb 15, 2024 | Covered |
| Intradiscal Procedures | Aug 30, 2023 | Covered |
| Vitiligo | Feb 16, 2024 | Covered |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Infliximab (Avsola, Inflectra, Remicade, & Renflexis) | Feb 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Infliximab – Community Plan Medical Benefit Drug Policy | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Infliximab (Avsola, Inflectra, Remicade, & Renflexis) – Individual Exchange Medical Benefit Drug Policy | 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 J1745 |
|---|---|---|
| Intravenous Infliximab and Related Biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Intravenous Infliximab and Related Biosimilars | 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 J1745 |
|---|---|---|
| Infliximab (e.g., Remicade and Unbranded Infliximab) and Biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Measurement of Serum Antibodies to Infliximab, Adalimumab, Vedolizumab, and Ustekinumab | 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 J1745 |
|---|---|---|
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Intravenous Infliximab. Medical Policy MP 5.01.668 Intravenous Infliximab DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross of Idaho benefit | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Measurement of Serum Antibodies to Selected Biologic Agents. Codes Number Description CPT 80145 Adalimumab 80230 Infliximab 80280 Vedolizumab 82397 Chemiluminescent assay 83520 | 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 J1745 |
|---|---|---|
| Infliximab (Remicade), infliximab-dyyb (Inflectra), and infliximab-abda (Renflexis), infliximab-qbtx (Ixifi), and infliximab-axxq (Avsola) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Measurement of Serum Antibodies to Infliximab, Adalimumab, Ustekinumab and Vedolizumab | 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 J1745 |
|---|---|---|
| Intravenous Infliximab and Related Biosimilars | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Intravenous Infliximab and Related Biosimilars | 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 J1745 |
|---|---|---|
| Infliximab (Avsola, Inflectra, Remicade, & Renflexis) | Feb 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1745 |
|---|---|---|
| MEASUREMENT OF SERUM ANTIBODIES TO INFLIXIMAB AND ADALIMUMAB | 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 J1745 |
|---|---|---|
| INFLIXIMAB POLICY | 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 J1745 |
|---|---|---|
| Infliximab | 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 J1745 |
|---|---|---|
| Infliximab Products: Infliximab (Remicade); Infliximab axxq (Avsola), Infliximab dyyb (Inflectra); Infliximab abda (Renflexis); Infliximab-dyyb (Zymfentra), Infliximab | Aug 1, 2000 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1745 |
|---|---|---|
| Specialty Exceptions Autoimmune-Infliximab Med B-Med B ABF 5290-D P2026 | 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 J1745 |
|---|---|---|
| Infliximab | 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 J1745 |
|---|---|---|
| Infliximab: Remicade; Inflectra; Renflexis; Avsola; Infliximab* | 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 J1745 |
|---|---|---|
| Zymfentra (infliximab-dyyb) Subcutaneous | 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 J1745 |
|---|---|---|
| Infliximab (Avsola, Inflectra, Remicade, & Renflexis) | Feb 1, 2026 | Covered |