Prior Auth Required

79403 - Pharmacy Radiopharmaceutical Therapy, Radiolabeled Monoclonal Antibody

This procedure appears on the selected insurer prior authorization source.

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Prior authorizationPrior Auth Required
Procedure / ServicePharmacy Radiopharmaceutical Therapy, Radiolabeled Monoclonal Antibody
Procedure / Service Description

Mountain Health Co-Op, Services Requiring Prior Authorization 68 - (Azedra, Xofigo) Pharmacy 79403 Radiopharmaceutical Therapy, Radiolabeled Monoclonal Antibody By Intravenous Infusion (Azedra)

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.