UnitedHealthcare · PayerPolicy · UHC-POL-adakveo-crizanlizumab-tmca
Summary of the payer’s published policy. Not a coverage determination — confirm with UnitedHealthcare before submitting.
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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.
| Code | Code system | Status in this policy |
|---|---|---|
| J0791 | HCPCS | Covered |
| D57.0 | ICD10CM | Covered |
| D57.00 | ICD10CM | Covered |
| D57.01 | ICD10CM | Covered |
| D57.02 | ICD10CM | Covered |
| D57.03 | ICD10CM | Covered |
| D57.04 | ICD10CM | Covered |
| D57.09 | ICD10CM | Covered |
| D57.1 | ICD10CM | Covered |
| D57.2 | ICD10CM | Covered |
| D57.20 | ICD10CM | Covered |
| D57.21 | ICD10CM | Covered |
| D57.211 | ICD10CM | Covered |
| D57.212 | ICD10CM | Covered |
| D57.213 | ICD10CM | Covered |
| D57.214 | ICD10CM | Covered |
|---|
| D57.218 | ICD10CM | Covered |
|---|
| D57.219 | ICD10CM | Covered |
|---|
| D57.3 | ICD10CM | Covered |
|---|
| D57.4 | ICD10CM | Covered |
|---|
| D57.40 | ICD10CM | Covered |
|---|
| D57.41 | ICD10CM | Covered |
|---|
| D57.411 | ICD10CM | Covered |
|---|
| D57.412 | ICD10CM | Covered |
|---|
| D57.413 | ICD10CM | Covered |
|---|
| D57.414 | ICD10CM | Covered |
|---|
| D57.418 | ICD10CM | Covered |
|---|
| D57.419 | ICD10CM | Covered |
|---|
| D57.42 | ICD10CM | Covered |
|---|
| D57.43 | ICD10CM | Covered |
|---|
| D57.431 | ICD10CM | Covered |
|---|
| D57.432 | ICD10CM | Covered |
|---|
| D57.433 | ICD10CM | Covered |
|---|
| D57.434 | ICD10CM | Covered |
|---|
| D57.438 | ICD10CM | Covered |
|---|
| D57.439 | ICD10CM | Covered |
|---|
| D57.44 | ICD10CM | Covered |
|---|
| D57.45 | ICD10CM | Covered |
|---|
| D57.451 | ICD10CM | Covered |
|---|
| D57.452 | ICD10CM | Covered |
|---|
| D57.453 | ICD10CM | Covered |
|---|
| D57.454 | ICD10CM | Covered |
|---|
| D57.458 | ICD10CM | Covered |
|---|
| D57.459 | ICD10CM | Covered |
|---|
| D57.8 | ICD10CM | Covered |
|---|
| D57.80 | ICD10CM | Covered |
|---|
| D57.81 | ICD10CM | Covered |
|---|
| D57.811 | ICD10CM | Covered |
|---|
| D57.812 | ICD10CM | Covered |
|---|
| D57.813 | ICD10CM | Covered |
|---|
| D57.814 | ICD10CM | Covered |
|---|
| D57.818 | ICD10CM | Covered |
|---|
| D57.819 | ICD10CM | Covered |
|---|