45 commercial payer policies list J3241. 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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45 policies from 26 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 J3241 |
|---|---|---|
| Tepezza (teprotumumab-trbw) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Tepezza (teprotumumab-trbw)Effective 04/01/2024 - 03/31/2025 | Apr 1, 2024 | Prior auth requiredInferred from policy title |
| Tepezza (teprotumumab-trbw)Effective 04/01/2025 - 03/31/2025 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Teprotumumab-trbw (Tepezza)Effective 04/01/2022 - 03/31/2023 | Apr 1, 2022 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Teprotumumab-trbw (Tepezza)Effective 04/01/2023 - 03/31/2024 | Apr 1, 2023 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Teprotumumab-trbw (Tepezza)Effective 06/01/2020 - 05/31/2021 | Jun 1, 2020 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Teprotumumab-trbw (Tepezza)Effective 06/01/2021 - 03/31/2022 | Jun 1, 2021 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of J3241 |
|---|---|---|
| Lumvoa (Veligrotug-Vvze) and Tepezza (Teprotumumab-Trbw) | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Tepezza (Teprotumumab-Trbw) – 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. |
| Tepezza (Teprotumumab-Trbw) – 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 J3241 |
|---|---|---|
| Teprotumumab (Tepezza) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Teprotumumab-trbw (Tepezza) | 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 J3241 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Teprotumumab-trbw | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J3241 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Teprotumumab-trbw | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J3241 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Teprotumumab-trbw | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J3241 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Teprotumumab-trbw | Apr 1, 2026 | Covered |
| Policy | Effective | Status of J3241 |
|---|---|---|
| State and School Employees' Health Insurance Plan - Tepezza (teprotumumab-trbw) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Tepezza (teprotumumab-trbw) | 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 J3241 |
|---|---|---|
| Teprotumumab-trbw (Tepezza) and veligrotug-vvze (Lumvoa) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Teprotumumab-trbw (Tepezza) and veligrotug-vvze (Lumvoa) – 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 J3241 |
|---|---|---|
| Teprotumumab (Tepezza) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Teprotumumab-trbw (Tepezza) | 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 J3241 |
|---|---|---|
| Tepezza (teprotumumab-trbw) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Tepezza (teprotumumab-trbw) | 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 J3241 |
|---|---|---|
| Lumvoa (Veligrotug-Vvze) and Tepezza (Teprotumumab-Trbw) | Oct 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J3241 |
|---|---|---|
| Teprotumumab-trbw (e.g., Tepezza) | 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 J3241 |
|---|---|---|
| TEPEZZA | 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 J3241 |
|---|---|---|
| TEPEZZA (TEPROTUMUMAB-TRBW) | 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 J3241 |
|---|---|---|
| Teprotumumab Trbw Tepezza | 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 J3241 |
|---|---|---|
| Tepezza (teprotumumab-trbw). MP 5.01.660 Tepezza CODES The following codes and coding guidance are provided for general reference purposes only and may not be all-inclusive. The inclusion of a | 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 J3241 |
|---|---|---|
| Teprotumumab-trbw (Tepezza) | Apr 1, 2020 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J3241 |
|---|---|---|
| Teprotumumab-trbw (Tepezza) | 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 J3241 |
|---|---|---|
| Teprotumumab (Tepezza); CP.PHAR.465 | 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 J3241 |
|---|---|---|
| Tepezza | 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 J3241 |
|---|---|---|
| Teprotumumab-trbw (Tepezza) | 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 J3241 |
|---|---|---|
| 00708 teprotumumab-trbw (Tepezza) | 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 J3241 |
|---|---|---|
| Tepezza (teprotumumab-trbw) | 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 J3241 |
|---|---|---|
| Tepezza (teprotumumab-trbw) (PG273, Ver. 1) | 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 J3241 |
|---|---|---|
| Lumvoa (Veligrotug-Vvze) and Tepezza (Teprotumumab-Trbw) | Oct 1, 2026 | Covered |