Medical Policy Updates

Medical Criteria Update April 6, 2022

Medical Criteria Reason for Update
Place of Service Added the following drugs and HCPCS codes for clarity, with criteria also available in individual policies: Nexviazyme (C9085, J3490, J3590), Saphnelo (C9086, J3490, J3590), Tezspire (C9399, J3490, J3590), Enjaymo (C9399** J3490**, J3590**), and Leqvio (C9399, J3490, J3590). Updated HCPCS code for Evkeeza to J1305.