21 commercial payer policies list J9210. 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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21 policies from 17 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 J9210 |
|---|---|---|
| Gamifant (Emapalumab-Lzsg) | Oct 1, 2026 | Covered |
| Gamifant (Emapalumab-Lzsg) – 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. |
| Gamifant (Emapalumab-Lzsg) – 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 J9210 |
|---|---|---|
| Emapalumab-lzsg (Gamifant) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Emapalumab-lzsg (Gamifant) | 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 J9210 |
|---|---|---|
| Emapalumab-lzsg (Gamifant) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Emapalumab-lzsg (Gamifant) | 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 J9210 |
|---|---|---|
| Emapalumab-LZSG (e.g., Gamifant) | 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 J9210 |
|---|---|---|
| GAMIFANT (EMAPALUMAB-LZSG) | 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 J9210 |
|---|---|---|
| Emapalumab Lzsg Gamifant | 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 J9210 |
|---|---|---|
| Emapalumab-lzsg (Gamifant) | Apr 30, 2019 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9210 |
|---|---|---|
| Gamifant (emapalumab-lzsg) | Dec 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9210 |
|---|---|---|
| Emapalumab-lzsg (Gamifant) | 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 J9210 |
|---|---|---|
| Emapalumab-lzsg (Gamifant); CP.PHAR.402 | 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 J9210 |
|---|---|---|
| Oncology - emapalumab-lzsg (Gamifant) | 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 J9210 |
|---|---|---|
| Gamifant | 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 J9210 |
|---|---|---|
| Emapalumab-lzsg (Gamifant) | 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 J9210 |
|---|---|---|
| 00678 emapalumab-lzsg (Gamifant) | 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 J9210 |
|---|---|---|
| Gamifant (emapalumab-lzsg) | 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 J9210 |
|---|---|---|
| Gamifant (Emapalumab-Lzsg) | Oct 1, 2026 | Covered |
| Policy | Effective | Status of J9210 |
|---|---|---|
| Gamifant (Emapalumab-Lzsg) | Oct 1, 2026 | Covered |