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Prior Authorization Guidelines Last update: June, 2010 Page 1 Health Choice of Arizona PRIOR AUTHORIZATION GUIDELINES It is with great pleasure that Health Choice provides ...

Policy Name Self-Administered Drugs

... joints), intrathecal injections, limited subcutaneous injections ... 07/01/2009 Updated codes 06/01/2009 Removed Lupron Depot, added Affinitor to code list 06/01 ...

2008 Table of Drugs

2008 Table of Drugs IA - Intra-arterial administration IV - Intravenous administration IM - Intramuscular administration IT - Intrathecal SC - Subcutaneous ...

2012 J Code Prior Authorization List

2012 J Code Prior Authorization List www.lipa.net J Code DESCRIPTION LIPA J0129 Abatacept 10 mg IV Yes J0597 Berinert, 10u Yes J0598 Cinryze, 10u Yes

Medicare Reimbursement for Lupron (OEI-03-03-00250; 01/04)

Office of Inspector General http://oig.hhs.gov The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, is to protect the ...

Understanding Specialty Pharmacy Management and Cost Control JUNE 2010

... IVchemotherapyandsupportiveagents,anddepotinjectionsofLupronor ... HCPCS J or Q Code specific to drug or drug class but not specific to ...


Lupron-DEPOT (leuprolide acetate) injections (including Lupron-DEPOT PED): Lupron-DEPOT ... Point-of-sale claims will deny if there is a billed J-code for ...


Page 2 SKU 95906 For technical questions, please call 1-800-444-3353. sPECIFICATIOns Drum Capacity 6 Cubic Feet Batch Capacity 1-1/2 to 2 Bags of cement Wheel to ...

HMO Blue Specialty Injectable Drug Program - J-Code Drug Name Discount

j-code drug name discount j0476 lioresal intrathecal awp ... awp- 16% j1830 betaseron awp- 15% j1950 lupron awp- 15% ... nutropin depot saizen serostim awp- 15% j3240 thyrogen ...

LUPRON DEPOT4 Month 30 mg

LUPRON DEPOT-4 Month 30 mg Package Insert Page 1 of 10 LUPRON DEPOT - 4 Month 30 mg ... in most (45/49) patients for as long as the patients received their injections.

Power Bike

Power Bike By Earl Seidlinqer ASOLINE-powered engines have been popular with bicycle enthusiasts ever since such engines were made small enough to fit a bicycle frame.

Presented below draft document during meeting with AUSA Michael ...

The Code of Federal Regulations (320.22) state ... Yet, it is the daily lupron injections which are mostly ... Depot lupron (long acting formulation) is also used in ...

Affiliated Computer Services

Lupron Depot. ACS Technical Call Center: PDL - Non-Preferred ... capsules HIC3=M0E Antihemophilic factors IV injections ... Code Level Code Values Drug Code Oral Chemotherapy ...


HCPCS 2001 TABLE OF DRUGS J Jenamicin, see Garamycin ... Leuprolide acetate (for depot suspension) 3 ... Lupron, see Leuprolide acetate. Lymphocyte immune globulin,

Medical Injection Prior Authorization List Coventry Health Care of ...

Effective 01/01/2012 Drug Name Code Code Drug Name Abraxane J9264 90283 Immune ... Koate-DVI/HP J7190 J1950 Lupron Depot Kogenate/FS J7192 J2020 Zyvok (linezolid)

Clinical Coverage Guideline

Supprelin LA (histrelin acetate) Subcutaneous Implant for the Treatment of Central Precocious Puberty (CPP)


RID:150: Abraham AM, Kavitha S, Joseph P, George R, Pillay D, Malathi J, et al ... can be successfully used to determine the content of ganciclovir in injections.

Ultrasound Measurements in Pregnancy

Code 02SPO . Special Projects Officer for the ... Alternatively, you may discontinue the injections and ... you could start the patient on DMPA (depot ...