Prior authorization codes

Simply Healthcare

Active CPT codes that appear on the extracted prior authorization list for this health plan.

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CodeProcedure / ServiceEffectiveRevisedConfidenceSource
J1437
ING-CC-0182 Monoferric
2022-04-01Not listed97%
[PDF] Prior authorization required for specialty pharmacy drugs
J1439
ING-CC-0182 Injectafer
2022-04-01Not listed97%
[PDF] Prior authorization required for specialty pharmacy drugs
J1750
ING-CC-0182 Infed
2022-04-01Not listed97%
[PDF] Prior authorization required for specialty pharmacy drugs
J1756
ING-CC-0182 Venofer
2022-04-01Not listed97%
[PDF] Prior authorization required for specialty pharmacy drugs
J2916
ING-CC-0182 Ferrlecit
2022-04-01Not listed97%
[PDF] Prior authorization required for specialty pharmacy drugs
Q0138
ING-CC-0182 Feraheme
2022-04-01Not listed97%
[PDF] Prior authorization required for specialty pharmacy drugs