Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list Q5151, and 17 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 Oct 1, 2025
17 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 Q5151 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5151 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 |
| Covered |
| Policy | Effective | Status of Q5151 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5151 |
|---|---|---|
| Eculizumab and Associated Biosimilar(s) | Dec 1, 2025 | Covered |
| Specialty Medication Administration Site of Care | Jan 1, 2026 | Covered |
| Policy | Effective | Status of Q5151 |
|---|---|---|
| Eculizumab Products (Soliris, Bkemv, Epysqli) | Not recorded | Prior auth requiredInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Eculizumab Products (Soliris, Bkemv, Epysqli)Effective 07/01/2025 - 06/30/2026 | Jul 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 Q5151 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5151 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |
| Provider Administered Drugs – Site of Care | Jul 1, 2026 | Covered |
| Policy | Effective | Status of Q5151 |
|---|---|---|
| Eculizumab (Soliris), Eculizumab-aeeb (Bkemv), Eculizumab-aagh (Epysqli); CP.PHAR.97 | 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 Q5151 |
|---|---|---|
| Eculizumab: Soliris; Bkemv; Epysqli | 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 Q5151 |
|---|---|---|
| Complement C5 Inhibitors | Apr 1, 2026 | Covered |