Q2043 coverage policies: Medicare and commercial | Backwork

Q2043 coverage policies: Medicare and commercial payers

1 active Medicare policy lists Q2043, and 19 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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Medicare policies listing Q2043

Article · A55719

Sipuleucel-T (Provenge) - Coverage Criteria for Prostate Cancer Clarification

National · Effective Oct 2, 2025

Commercial payer policies listing Q2043

19 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.

AmeriHealth

AmeriHealth policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Personalized Vaccines (e.g., Provenge)PayerPolicy · AMERIHEALTH-COMMERCIAL-08-00-95	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
Personalized Vaccines (e.g., Provenge)PayerPolicy · AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-053	Not recorded	Covered with conditionsInferred from policy title

Independence Blue Cross

Independence Blue Cross policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Personalized Vaccines (e.g., Provenge)PayerPolicy · IBX-COMMERCIAL-08-00-95	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.
Personalized Vaccines (e.g., Provenge)PayerPolicy · IBX-MEDICARE-ADVANTAGE-MA08-053	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Arkansas Blue Cross and Blue Shield

Arkansas Blue Cross and Blue Shield policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Sipuleucel-T (e.g., Provenge) for the Treatment of Prostate CancerPayerPolicy · ARKBLUE-SIPULEUCEL-T-E-G-PROVENGE-FOR-THE-TREATMENT-OF-PROSTATE-CANCER	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Blue Cross Blue Shield of Michigan and Blue Care Network

Blue Cross Blue Shield of Michigan and Blue Care Network policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
AIM MEDICAL POLICY - SIPULEUCEL-T: PROVENGE (Q2043) (RETIRED AS OF 02/02/2023)PayerPolicy · BCBSM-2070041	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

BlueCross BlueShield of Tennessee

BlueCross BlueShield of Tennessee policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Sipuleucel-T (Provenge)PayerPolicy · BCBSTN-b1549241fe	Oct 9, 2010	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Cigna

Cigna policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Cigna MedOnc Master Drug List.pdfPayerPolicy · EVICORE-HPLAN-CIGNA-18A0ACC73CE9	Not recorded	Prior auth required

Health Net Oregon

Health Net Oregon policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Sipuleucel-T (Provenge); CP.PHAR.120PayerPolicy · HEALTHNET_OR-CP-PHAR-120	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Health Partners Plans / Jefferson Health Plans

Health Partners Plans / Jefferson Health Plans policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Q3 - 2026 Jefferson Health Plans MedOnc Master Drug ListPayerPolicy · EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5	Not recorded	Prior auth required

Horizon BCBSNJ

Horizon BCBSNJ policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Sipuleucel-T (Provenge)PayerPolicy · BCBSNJ-DRUGS-078-A871F7810B	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Louisiana Blue

Louisiana Blue policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
00264 sipuleucel-T (Provenge)PayerPolicy · BCBSLA-00264-35A9890F5B	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Mass General Brigham Health Plan

Mass General Brigham Health Plan policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
ProvengePayerPolicy · MGBHP-PROVENGE-0D03BF0646	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Moda Health

Moda Health policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Provenge (sipuleucel-T)PayerPolicy · MODA-SIPULEUCEL-4D7E043ECC	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.

Point32Health

Point32Health policies listing Q2043, with the code’s status in each
Policy	Effective	Status of Q2043
Provenge (sipuleucel-T)PayerPolicy · POINT32HEALTH-MDMNG-13496	Not recorded	Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug.