Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list Q5126, and 13 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
J6 · Effective Jul 1, 2026
13 policies from 13 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 Q5126 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Oncology Medications |
| Jul 1, 2026 |
| Covered |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Bevacizumab Products (Avastin; Mvasi ; Zirabev; Alymsys; Vegzelma, Avzivi, Jobevne) | Feb 1, 2005 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Bevacizumab (Alymsys, Avastin, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev); CP.PHAR.93 | 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 Q5126 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Oncology - bevacizumab (Avastin, Mvasi, Zirabev, Alymsys, Vegzelma, Jobevne) | 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 Q5126 |
|---|---|---|
| Bevacizumab: Alymsys; Avastin; Avzivi; Jobevne; Mvasi; Vegzelma; Zirabev | 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 Q5126 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of Q5126 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |