Home - Medical Policies - Alabama
Policies & Guidelines
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- Medical Policies
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy Management (RTM)
- Self-Administered Drug Policies
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Provider-Administered Drug Claim Edit Policies
For the provider-administed drugs identified below, claims submitted to the plan must include an appropriate diagnosis code within the drug's policy criteria for claims to process. Any claims submitted with a diagnosis code not found within the policy for that drug, will reject as non-covered.
Precertification criteria does not apply for these policies.
| Policy # | Policy Title | Print View |
|---|---|---|
| PH-0239 | Dysport (abobotulinumtoxinA) | |
| PH-0241 | Xeomin (incobotulinumtoxinA) |
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