Blue Cross Blue Shield of North Dakota · Policy reference
An overview has not been extracted for this policy. Read the original document for its requirements and exceptions.
Each code’s status is what the policy records for it. This page does not show the policy’s criteria. Read them in the payer’s source.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Code | Code system | Status in this policy |
|---|---|---|
| J9205 | HCPCS | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
Not a coverage determination — confirm with Blue Cross Blue Shield of North Dakota before submitting.