Member Policies - Medical Policies - Alabama
- Advanced Imaging
- Autism Spectrum Mandate
- Behavioral Health
- Blue Advantage Policies
- Chronic Condition Management
- Genetic Testing Management
- Hemophilia Drug Management
- Medical Policies
- Provider-Administered Drug Policies (Excluding Oncology)
- Provider-Administered Oncology Drug Policies
- Radiation Therapy Management (RTM)
- Self-Administered Drug Policies
- Transgender Services
Current Provider-Administered Oncology Drug Policies
Kanjinti: See VP-0057 below.
Kymriah: For dates of service on or after January 1, 2019, through December 31, 2020, providers or facilities need to send requests and/or claims to Original Medicare. See Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers (CAG-00451N).
Nyvepria: See VP-0234 below.
Trazimera: See VP-0057 below.
Yescarta: For dates of service on or after January 1, 2019, through December 31, 2020, providers or facilities need to send requests and/or claims to Original Medicare. See Decision Memo for Chimeric Antigen Receptor (CAR) T-cell Therapy for Cancers (CAG-00451N).
Ziextenzo: See VP-0234 below.
For billing and coding for Rituximab, refer to LCD L35026/Article A56380 for the following drugs:
Rituxan |
Truxima |
Ruxience |
For billing and coding for chemotherapy, refer to Palmetto article A56141 for the following drugs:
Adcetris |
Aliqopa |
Arzerra |
Bavencio |
Beleodaq |
Belrapzo |
Bendeka |
Besponsa |
Blincyto |
bortezomib, not otherwise specified |
Campath |
Cyramza |
Darzalex |
Doxil |
Imfinzi |
Empliciti |
Erwinaze |
Gazyva |
Halaven |
Herceptin |
Herceptin Hylecta |
Herzuma |
Istodax |
Ixempra |
Kadcyla |
Keytruda |
Kyprolis |
Lartruvo |
Lutathera |
Mylotarg |
Ogivri | Onivyde | Ontruzant |
Opdivo |
Perjeta |
Portrazza |
Poteligeo |
Tecentriq |
Torisel |
Treanda |
Velcade |
Vumon |
Vyxeos |
Yervoy |
Yondelis |
Zaltrap |
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For white cell colony stimulating factors, refer to LCD L37176/A56748 for the following drugs:
Fulphila | Granix | Leukine |
Neulasta | Neupogen | Nivestym |
Udenyca | Zarxio |