Example: marketing

508C Provider-Administered Specialty Pharmacy Products

Provider-Administered Specialty Pharmacy Products The drugs on the list below need to be ordered by a provider and administered in an office or outpatient setting. For medications that need prior authorization, providers can: . Log in to Availity . Select the Tennessee region, and then select Payer Space.. Click the Authorization Submission/Review application. Select Specialty Pharmacy .. Call 1-888-258-3864 for Medicare Advantage members. Call 1-888-258-3864 for BlueCare Plus members. HCPCS Code Drug Name HCPCS Code Drug Name HCPCS Code Drug Name J9264 AbraxanePA J1566 Carimune NFPA J9307 FolotynPA. J3262 ActemraPA J1786 CerezymePA Q5108 FulphilaPA. J0800 Acthar HPPA J0717 CimziaPA J0641 FusilevST/PA. PA PA. J2504 Adagen J2786 Cinqair J1569 GammagardPA Liquid J9042 AdcetrisPA J0598 CinryzePA J1566 GammagardPA S/D (powder).

The drugs on the list below need to be ordered by a provider and administered in an office or outpatient setting. For medications that need prior authorization, providers can:

Tags:

  Product, Specialty, Provider, Pharmacy, Administered, Provider administered specialty pharmacy products

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of 508C Provider-Administered Specialty Pharmacy Products

1 Provider-Administered Specialty Pharmacy Products The drugs on the list below need to be ordered by a provider and administered in an office or outpatient setting. For medications that need prior authorization, providers can: . Log in to Availity . Select the Tennessee region, and then select Payer Space.. Click the Authorization Submission/Review application. Select Specialty Pharmacy .. Call 1-888-258-3864 for Medicare Advantage members. Call 1-888-258-3864 for BlueCare Plus members. HCPCS Code Drug Name HCPCS Code Drug Name HCPCS Code Drug Name J9264 AbraxanePA J1566 Carimune NFPA J9307 FolotynPA. J3262 ActemraPA J1786 CerezymePA Q5108 FulphilaPA. J0800 Acthar HPPA J0717 CimziaPA J0641 FusilevST/PA. PA PA. J2504 Adagen J2786 Cinqair J1569 GammagardPA Liquid J9042 AdcetrisPA J0598 CinryzePA J1566 GammagardPA S/D (powder).

2 PA PA. J7192 Advate J7175 Coagadex J1561 GammakedPA. J7207 AdynovatePA J7180 CorifactPA J1557 GammaplexPA. J7210 AfstylaPA J0584 CrysvitaPA J1561 Gamunex-CPA. PA PA. J1454 Akynzeo J1555 Cuvitru J9301 GazyvaPA. J1931 AldurazymePA J9308 CyramzaPA J7326 Gel-OnePA. PA PA. J9305 Alimta J9145 Darzalex J7328 Gel-SynPA. J9057 AliqopaPA J7318 DurolanePA J7320 GenviscPA. J2469 AloxiST/PA J0586 DysportPA J0257 GlassiaPA. PA PA. J7186 Alphanate J1743 Elaprase J0599 HaegardaPA. J7193 Alphanine SDPA J3060 ElelysoPA J9179 HalavenPA. PA PA. J7201 Alprolix J9217 Eligard J7192 Helixate FSPA. J0256 AralastPA J7205 EloctatePA J7170 HemlibraPA. J0882 AranespPA (ESRD on dialysis) J9176 EmplicitiPA J7190 Hemofil MPA. PA PA. J0881 Aranesp (non-ESRD) J3380 Entyvio J9355 HerceptinPA. J9261 ArranonPA Q4081 EpogenPA (ESRD) J1559 HizentraPA.

3 PA PA. J9302 Arzerra J0885 Epogen (non-ESRD) J7187 Humate-PPA. J9035 AvastinPA (oncology only) J1325 EpoprostenolPA J7321 HyalganPA. J9023 BavencioPA J9055 ErbituxPA J7322 HymovisPA. PA PA. J7194 Bebulin J7323 Euflexxa J1575 HyqviaPA. J9032 BeleodaqPA J1428 Exondys 51PA J7202 IdelvionPA. PA ST/PA. J7195 BeneFIX J0178 Eylea J0638 IlarisPA. J9034 BendekaPA J0180 FabrazymePA J3245 Ilumya PA. J0490 BenlystaPA J0517 FasenraPA J7313 IluvienPA. PA PA. J0597 Berinert J7198 Feiba J9173 ImfinziPA. J9229 BesponsaPA J7198 Feiba NFPA J9325 ImlygicPA. PA PA. J1556 Bivigam J1744 Firazyr Q5103 InflectraPA. J9039 BlincytoPA J9155 FirmagonPA J9315 IstodaxPA. J9044 BortezomibPA J1572 FlebogammaPA. J0585 Botox PA J1325 FlolanPA. HCPCS Code Drug Name HCPCS Code Drug Name HCPCS Code Drug Name PA PA. J9207 Ixempra J3490 Onpattro J3590 TakhzyroPA.

4 PA PA. J7195 Ixinity J9299 Opdivo J9022 TecentriqPA. PA. J7316 Jetrea J0129 Orencia IV PA. J3490 Tegsedi PA. J9043 JevtanaPA J7324 OrthoviscPA J9328 Temodar PA. PA. J7199 Jivi J7312 Ozurdex PA J3490 TestopelPA. J9354 KadcylaPA J1599 PanzygaPA J3240 ThyrogenPA. PA. J1290 Kalbitor J9306 PerjetaPA J9330 ToriselPA. J2840 KanumaPA J9295 PortrazzaPA J9033 TreandaPA. J9271 KeytrudaPA J9999 PoteligeoPA J3315 Trelstar DepotPA. PA PA. Q5111 Khapzory J1459 Privigen J7181 TrettenPA. J7190 Koate-DVIPA J0885 Procrit/EpogenPA (non-ESRD) J3316 TriptodurPA. PA. J7192 Kogenate FS J7194 Profilnine SDPA J7329 TriViscPA. PA PA. J7211 Kovaltry J0256 Prolastin C J1746 TrogarzoPA. J2507 KrystexxaPA J9015 ProleukinPA J2323 TysabriPA. Q2042 *Kymriah PA. J0897 Prolia ST/PA. J7686 TyvasoPA. J9047 KyprolisPA Q2043 ProvengePA J3490 UdenycaPA.

5 PA. J9285 Lartruvo J1301 RadicavaPA J9225 VantasPA. J0202 Lemtrada PA. J7203 Rebinyn PA. J9303 VectibixPA. J2820 LeukinePA J3489 ReclastPA J9041 VelcadePA. PA PA. J9999 Libtayo J7192 Recombinate J1325 VeletriPA. J2778 LucentisPA J1745 RemicadePA J9025 VidazaPA. PA. J0221 Lumizyme J3285 RemodulinPA J1322 VimizimPA. PA PA. J9999 Lumoxiti Q5104 Renflexis J7321 Visco-3PA. J1950 Lupron DepotPA (endocrine use) Q5106 RetacritPA (non-ESRD) J3396 VisudynePA. PA. J9217 Lupron DepotPA (antineoplastic use) Q5105 Retacrit (ESRD on dialysis) J7179 VonvendiPA. J3398 LuxturnaPA J7311 RetisertPA J3385 VPRIVPA. J2503 MacugenPA J3590 RevcoviPA J9153 VyxeosPA. PA PA. J9371 Marqibo J9312 Rituxan J7183 WilatePA. J3397 MepseviiPA J9311 Rituxan HycelaPA J0588 XeominPA. PA PA. J0887 Mircera (ESRD on dialysis) J7200 Rixubis J0897 XgevaST/PA.

6 J0888 MirceraPA (non-ESRD) J0596 RuconestPA J0775 XiaflexPA. J7190 Monoclate-PPA J2353 Sandostatin LAR DepotPA J7185 XynthaPA. PA PA. J7193 Mononine J2502 Signifor LAR J2357 XolairPA. J7327 MonoviscPA J1602 Simponi AriaPA J9228 YervoyPA. PA PA. J9203 Mylotarg J1300 Soliris Q2041 *YescartaPA. J0587 MyoblocPA J1930 Somatuline DepotPA J9352 YondelisPA. J1458 NaglazymePA J2326 SpinrazaPA J3490 YutiqPA. PA PA. J2505 Neulasta J3357 Stelara SC J9400 ZaltrapPA. J7182 NovoeightPA J3358 Stelara IVPA J0256 ZemairaPA. PA. J7189 Novoseven RT J7321 SupartzPA J9202 ZoladexPA. J2796 NplatePA J9226 Supprelin LAPA J3489 ZometaPA. J2182 NucalaPA J1627 SustolST/PA. PA. J7209 Nuwiq J2860 SylvantPA. J7188 ObizurPA J9262 SynriboPA. J2350 OcrevusPA J3490 SynojoyntPA. PA. J1568 Octagam J7325 SynviscPA. PA. J9205 Onivyde J7325 Synvisc-OnePA.

7 *Also requires an inpatient authorization PA Requires a Prior Authorization ST Requires Step Therapy 1 Cameron Hill Circle Chattanooga,TN 37402. BlueCross BlueShield of Tennessee, Inc., an Independent Licensee of the Blue Cross Blue Shield Association. BlueAdvantage is a PPO plan with a Medicare contract. Enrollment in BlueAdvantage depends on contract renewal. BlueCare Plus Tennessee, an Independent Licensee of the Blue Cross Blue Shield Association. BlueCare Plus is an HMO SNP plan with a Medicare contract and a contract with the Tennessee Medicaid Program. Enrollment in BlueCare Plus depends on contract renewal. 18 PED291145 (4/19) provider administered Specialty List-Word Templat


Related search queries