Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list Q5128, and 12 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
12 policies from 8 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 Q5128 |
|---|---|---|
| Ranibizumab (Lucentis, Byooviz, and Cimerli) Injection | Jan 1, 2026 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Ranibizumab (Lucentis, Byooviz, and Cimerli) InjectionEffective 01/01/2023 - 12/31/2023 | Jan 1, 2023 | Prior auth requiredInferred from policy title |
| Ranibizumab (Lucentis, Byooviz, and Cimerli) InjectionEffective 01/01/2025 - 12/31/2025 | Jan 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ranibizumab (Lucentis, Byooviz, and Cimerli)Effective 01/01/2024 - 12/31/2024 | Jan 1, 2024 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ranibizumab (Lucentis, Byooviz, Nufymco and Cimerli) InjectionEffective 10/01/2026 | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Policy | Effective | Status of Q5128 |
|---|---|---|
| Non-Bevacizumab Vascular Epithelial Growth Factors for Ophthalmic Use (e.g., Beovu, Byooviz, Cimerli, Eylea, Eylea HD, Lucentis, Pavblu, Vabysmo, Enzeevu, Ahzantive, Yesafili, Opuviz) | 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 Q5128 |
|---|---|---|
| Ranibizumab (Lucentis, Byooviz; Cimerli) | Dec 1, 2016 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q5128 |
|---|---|---|
| Ranibizumab (Byooviz, Cimerli, Lucentis, Nufymco, Susvimo); CP.PHAR.186 | 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 Q5128 |
|---|---|---|
| Ranibizumab: Lucentis; Byooviz; Cimerli | 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 Q5128 |
|---|---|---|
| Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5128 |
|---|---|---|
| Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5128 |
|---|---|---|
| Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors | Jul 1, 2026 | Covered |