Policy library / J7177 Commercial payer policies listing J7177 7 policies from 5 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.
EviCore by Evernorth policies listing J7177, with the code’s status in each Policy Effective Status of J7177 Fibrinogen Products (RiaSTAP, Fibryga) PayerPolicy · EVICORE-MEDICAL_DRUG-9D3020ADE894 Not recorded Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. Fibrinogen Products (RiaSTAP, Fibryga)Effective 12/01/2025 - 04/30/2026 PayerPolicy · EVICORE-MEDICAL_DRUG-E7CE64F816C4 Dec 1, 2025 Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.