Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
3 active Medicare policies list Q5167, and 5 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
5 policies from 5 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
| Policy | Effective | Status of Q5167 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5167 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of Q5167 |
|---|---|---|
| Denosumab |
| Oct 1, 2026 |
| Covered |
| Policy | Effective | Status of Q5167 |
|---|---|---|
| Denosumab | Oct 1, 2026 | Covered |
| Policy | Effective | Status of Q5167 |
|---|---|---|
| Denosumab | Oct 1, 2026 | Covered |