Prior Auth Required

66658 - Availability 10 mg/2 mL single-dose vial (NDC -501-01)

This procedure appears on the selected insurer prior authorization source.

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Procedure / ServiceAvailability 10 mg/2 mL single-dose vial (NDC -501-01)
Procedure / Service Description

Indications Hemophagocytic lymphohistiocytosis - Indications Hemophagocytic lymphohistiocytosis ICD10 diagnosis codes D76.1 Availability 10 mg/2 mL single-dose vial (NDC 66658-501-01) 50 mg/10 mL single-dose vial (NDC 66658-505-01) 100 mg/20 mL single-dose vial (NDC 66658-510-01)

Likely documents
  • Confirm benefit details
  • Submit clinical notes if requested by the plan
Next actions
  • Confirm the current plan policy before submission.
  • Use the insurer authorization workflow for this listed code.