Prior Auth Required

96413 - Example 1: Oncology drug, Yervoy ( ) requires prior auth listed below which the corresponding administration CPT code, , would be identified as a supportive

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServiceExample 1: Oncology drug, Yervoy ( ) requires prior auth listed below which the corresponding administration CPT code, , would be identified as a supportive
Procedure / Service Description

For the products and UM Programs that require prior authorization for the listed drugs, a separate review is NOT required for the administration/ supportive services unless separately identified. Example 1: Oncology drug, Yervoy (J9228) requires prior auth listed below which the corresponding administration CPT code, 96413, would be identified as a supportive Example 2: Eye injection, Lucentis (J2778) requires prior auth listed below which the corresponding administration CPT code, 67028, would be identified as a supportive

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.