19 commercial payer policies list Q5138. 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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19 policies from 10 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 Q5138 |
|---|---|---|
| Ustekinumab Intravenous (Stelara , Otulfi, Pyzchiva , Selarsdi, Steqeyma, Wezlana, Yesintek, ustekinumab-ttwe)Effective 06/01/2025 - 10/31/2025 | Jun 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Ustekinumab Intravenous (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Starjemza, Steqeyma, Wezlana, Yesintek, ustekinumab, ustekinumab-ttwe) | Not recorded | Prior auth requiredInferred from policy title |
| Ustekinumab Intravenous (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Steqeyma , Wezlana, Yesintek , ustekinumab, ustekinumab-ttwe)Effective 11/01/2025 - 03/31/2026 | Nov 1, 2025 | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
|---|
| Ustekinumab Intravenous (Stelara, Wezlana)Effective 04/01/2025 - 05/31/2025 | Apr 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 Q5138 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Ustekinumab and Associated Biosimilars | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Ustekinumab and Associated Biosimilars | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Ustekinumab and Associated Biosimilars | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Ustekinumab and Associated Biosimilars | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Ustekinumab | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Provider Administered Drugs – Site of Care | Oct 1, 2026 | Covered |
| Ustekinumab | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Ustekinumab Products: Ustekinumab (Stelara); Ustekinumab-auub (Wezlana); Ustekinumab-srlf (Imuldosa); Ustekinumab-aauz (Otulfi); Ustenkinumab-ttwe (Pyzchiva), Ustekinumab-aekn (Selarsdi); Ustenkinumab-stba (Steqeyma); Ustenkinumba-kfce (Yesintek); ustekinumab; ustekinumab-aauz, ustekinumab-stba, ustekinumab-aekn ; ustenkinumab-ttwe; Ustekinumab-hmny (Starjemza) | Mar 11, 2010 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of Q5138 |
|---|---|---|
| Ustekinumab: Stelara; Wezlana; Selarsdi; Pyzchiva; Otulfi; Imuldosa; Yesintek; Steqeyma; Starjemza; Ustekinumab-aekn§; Ustekinumab-ttwe§; Ustekinumab-aauz§; Ustekinumab-stba§; Ustekinumab§ | 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 Q5138 |
|---|---|---|
| Ustekinumab | Jul 1, 2026 | Covered |