Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
9 active Medicare policies list J3590, and 121 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
JJ · Effective Oct 1, 2015
JM · Effective Oct 1, 2015
National · Effective Jun 12, 2025
J6 · Effective Jul 1, 2026
National · Effective Dec 26, 2024
J6 · Effective Jul 1, 2026
National · Effective Oct 1, 2025
121 policies from 12 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Showing 10 of 17 · All BCBS Illinois policies
| Policy | Effective | Status of J3590 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Elivaldogene autotemcel | Jan 1, 2026 | Covered |
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Etranacogene dezaparvovec-drlb |
| Jan 1, 2026 |
| Covered |
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
|---|
| Gene Therapy for Aromatic L-amino Acid Decarboxylase Deficiency | Nov 15, 2025 | Covered |
|---|
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
|---|
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
|---|
Showing 10 of 17 · All BCBS Montana policies
| Policy | Effective | Status of J3590 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Elivaldogene autotemcel | Jan 1, 2026 | Covered |
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Etranacogene dezaparvovec-drlb | Jan 1, 2026 | Covered |
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Gene Therapy for Aromatic L-amino Acid Decarboxylase Deficiency | Nov 15, 2025 | Covered |
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
Showing 10 of 17 · All BCBS New Mexico policies
| Policy | Effective | Status of J3590 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Elivaldogene autotemcel | Jan 1, 2026 | Covered |
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Etranacogene dezaparvovec-drlb | Jan 1, 2026 | Covered |
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Gene Therapy for Aromatic L-amino Acid Decarboxylase Deficiency | Nov 15, 2025 | Covered |
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
Showing 10 of 17 · All BCBS Oklahoma policies
| Policy | Effective | Status of J3590 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Denosumab and Biosimilars for Non-Oncologic Indications | Jan 1, 2026 | Covered |
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Elivaldogene autotemcel | Jan 1, 2026 | Covered |
| Enzyme-Replacement Therapy for Lysosomal Storage Disorders | Jan 1, 2026 | Covered |
| Etranacogene dezaparvovec-drlb | Jan 1, 2026 | Covered |
| FDA - Drugs, Biologicals, Cellular and Gene Therapies | Aug 1, 2026 | Covered |
| Gene Therapy for Aromatic L-amino Acid Decarboxylase Deficiency | Nov 15, 2025 | Covered |
| Immunoglobulin Therapy | Jan 1, 2026 | Covered |
| Infliximab and Associated Biosimilars | Jan 1, 2026 | Covered |
Showing 10 of 11 · All UMR (UnitedHealthcare) policies
| Policy | Effective | Status of J3590 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Kebilidi (Eladocagene Exuparvovec-Tneq) | Aug 1, 2026 | Covered |
| Lumvoa (Veligrotug-Vvze) and Tepezza (Teprotumumab-Trbw) | Oct 1, 2026 | Covered |
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Otarmeni (Lunsotogene Parvec-Cwha) | Oct 1, 2026 | Covered |
| Papzimeos (Zopapogene Imadenovec-Drba) | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Review at Launch for New to Market Medications | Dec 1, 2025 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) | Jan 1, 2026 | Covered |
| Ustekinumab | Jul 1, 2026 | Covered |
Showing 10 of 11 · All UnitedHealthcare policies
| Policy | Effective | Status of J3590 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Kebilidi (Eladocagene Exuparvovec-Tneq) | Aug 1, 2026 | Covered |
| Lumvoa (Veligrotug-Vvze) and Tepezza (Teprotumumab-Trbw) | Oct 1, 2026 | Covered |
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Otarmeni (Lunsotogene Parvec-Cwha) | Oct 1, 2026 | Covered |
| Papzimeos (Zopapogene Imadenovec-Drba) | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Review at Launch for New to Market Medications | Dec 1, 2025 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) | Jan 1, 2026 | Covered |
| Ustekinumab | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J3590 |
|---|---|---|
| Clotting Factors, Coagulant Blood Products, & Other Hemostatics | Oct 1, 2026 | Covered |
| Kebilidi (Eladocagene Exuparvovec-Tneq) | Aug 1, 2026 | Covered |
| Lumvoa (Veligrotug-Vvze) and Tepezza (Teprotumumab-Trbw) | Oct 1, 2026 | Covered |
| Medical Therapies for Enzyme Deficiencies | Oct 1, 2026 | Covered |
| Otarmeni (Lunsotogene Parvec-Cwha) | Oct 1, 2026 | Covered |
| Papzimeos (Zopapogene Imadenovec-Drba) | Apr 1, 2026 | Covered |
| Review at Launch for New to Market Medications | Dec 1, 2025 | Covered |
| Rituximab (Riabni, Rituxan, Ruxience, & Truxima) | Jan 1, 2026 | Covered |
| Ustekinumab | Jul 1, 2026 | Covered |
| White Blood Cell Colony Stimulating Factors | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J3590 |
|---|---|---|
| Cellular Therapy Products for Allogeneic Stem Cell Transplantation | Oct 1, 2026 | Covered |
| Gene Therapy for Aromatic L-Amino Acid Decarboxylase Deficiency | Apr 15, 2026 | Not covered |
| Gene Therapy for Beta Thalassemia | Aug 27, 2026 | Covered |
| Gene Therapy for Duchenne Muscular Dystrophy | Oct 1, 2026 | Covered |
| Gene Therapy for Hemophilia | May 28, 2026 | Covered |
| Gene Therapy for Ocular Conditions | Apr 15, 2026 | Covered |
| Gene Therapy for Sickle Cell Disease | Aug 27, 2026 | Covered |
| Implanted Port Delivery Systems to Treat Ocular Disease | Apr 15, 2026 | Not covered |
| Thymus Tissue Transplantation | Apr 15, 2026 | Covered |
| Policy | Effective | Status of J3590 |
|---|---|---|
| Amtagvi (lifileucel) | Aug 3, 2026 | Covered |
| Gene Therapy Treatments for Sickle Cell Disease | Feb 2, 2026 | Covered |
| Kebilidi (eladocagene exuparvovec-tneq) | Mar 2, 2026 | Covered |
| Rethymic (allogenic processed thymus tissue - agdc) | Oct 1, 2025 | Covered |
| Umbilical Cord Blood Transplantation | Jun 1, 2026 | Covered |
| Zevaskyn (prademagene zamikeracel) | Jun 1, 2026 | Covered |
| Policy | Effective | Status of J3590 |
|---|---|---|
| Breast Reconstruction Following Mastectomy or Lumpectomy | Apr 15, 2026 | Not covered |
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Injectable Fillers for Head and Neck Conditions | Jun 15, 2026 | Covered |
| Policy | Effective | Status of J3590 |
|---|---|---|
| Allogeneic Hematopoietic Progenitor Cell Therapy | Not recorded | Covered |
| Lantidra (donislecel): Allogeneic Pancreatic Islet Cellular Therapy | Not recorded | Covered |
| Policy | Effective | Status of J3590 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |