Transcription of Maximum Dosage and Frequency - UHCprovider.com
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Maximum Dosage and Frequency - UHCprovider.com
Maximum Dosage and Frequency Page 1 of 19 UnitedHealthcare Commercial Medical Benefit Drug Policy Effective 01/01/2022 Proprietary Information of UnitedHealthcare. Copyright 2022 United HealthCare Services, Inc. UnitedHealthcare Commercial Medica l Benefit Drug Policy Maximum Dosage and Frequency Policy Number: 2022D0034AF Effective Date: January 1, 2022 Instructions for Use Table of Contents Page Coverage Rationale .. 1 Applicable Codes .. 12 Benefit Considerations .. 16 Clinical Evidence .. 16 References .. 17 Policy History/Revision Information .. 18 Instructions for Use.
90 mg . J3357 . 90 HCPCS units (1 mg per unit) Crohn’s Disease . 520 mg ; J3358 . 520 HCPCS units (1 mg per unit) Testopel . testosterone pellet ; 450 mg . S0189 . 6 HCPCs units (75 mg per unit) Ultomiris . ravulizumab-cwvz ; 3,600 mg . J1303 . 360 HCPCS units (10 mg per unit) Xolair . omalizumab ; Asthma . 375 mg ; J2357 . 90 HCPCS units (5 ...
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