Prior Auth Required

69025 - 2025. Consistent with policies adopted in the CY 2016 and CY 2023 ESRD PPS final rules (see 80 FR and 87 FR )

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / Service2025. Consistent with policies adopted in the CY 2016 and CY 2023 ESRD PPS final rules (see 80 FR and 87 FR )
Procedure / Service Description

any dose of phosphate binder therapy. CMS has also determined that XPHOZAHTM meets the current regulatory definition of an oral-only - any dose of phosphate binder therapy. CMS has also determined that XPHOZAHTM meets the current regulatory definition of an oral-only drug as defined at § 413.234(a), and therefore, in accordance with § 413.174(f)(6), is not paid for under the ESRD PPS until January 1, 2025. Consistent with policies adopted in the CY 2016 and CY 2023 ESRD PPS final rules (see 80 FR 69025 and 87 FR 67183), XPHOZAHTM will be included in the ESRD PPS effective January 1, 2025, using the drug designation process under § 413.234.

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.