Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
4 active Medicare policies list Q5147, 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
National · Effective Oct 1, 2025
J6 · Effective Jan 1, 2026
13 policies from 11 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 Q5147 |
|---|---|---|
| Aflibercept (Eylea, Eylea HD, Pavblu) Injection | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Aflibercept (Eylea, Eylea HD, Pavblu) InjectionEffective 05/01/2025 - 04/30/2026 | May 1, 2025 | Prior auth requiredInferred from policy title |
| Aflibercept (Eylea, Eylea HD, Pavblu) InjectionEffective 05/01/2026 - 07/31/2026 | 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 Q5147 |
|---|---|---|
| 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 Q5147 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5147 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5147 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5147 |
|---|---|---|
| Aflibercept and Associated Biosimilar(s) | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5147 |
|---|---|---|
| Aflibercept Products (Eylea; EyleaHD, Ahzantive [aflibercept-mrbb], Enzeevu [Aflibercept-abzv], Eydenzelt [Aflibercept-boav], Opuviz [Aflibercept-yszy], Pavblu [Aflibercept-ayyh], and Yesafili [Aflibercept-jbvf]) | 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 Q5147 |
|---|---|---|
| Aflibercept: Ahzantive; Enzeevu; Eydenzelt; Eylea; Eylea HD; Opuviz; Pavblu; Yesafili | 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 Q5147 |
|---|---|---|
| Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5147 |
|---|---|---|
| Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5147 |
|---|---|---|
| Ophthalmologic Vascular Endothelial Growth Factor (VEGF) Inhibitors | Jul 1, 2026 | Covered |