Cook Childrens Health PlanCommercial Clinical Policy

Prior Authorization Updates December 2023 Form

Chat with GenHealth to automate any policy or prior auth task.


Prior Authorization Updates December 2023

Indications

(10001) Is the drug PR INJ, ABILIFY ASIMTUFII, 1 MG (C9152) covered under the policy? 
(10002) Is the coverage effective as of 1/1/2024? 
(20001) Is PR INJ, AMISULPRIDE, 1 MG (C9153) covered under the policy as of 1/1/2024? 
(30001) Is the drug PR INJ BUPRENORPH (BRIXADI) 1MG (C9154) covered under the policy? 
(30002) Is the coverage effective as of 1/1/2024? 

YesNoN/A
YesNoN/A
YesNoN/A

Sign up to see the rest of the questions

Unlock the remaining questions and the full coverage workflow.

Sign up for free
Effective Date

NA

Last Reviewed

NA

Original Document

  Reference



022624

Prior Authorization Updates December 2023

Cook Children’s Health Plan has updated the following procedure codes with an effective date of 01/01/2024. Providers may contact CCHPPriorAuthorizations@cookchildrens.org with questions specific to authorizations. For additional questions please contact Cook Children’s Health Plan Provider Support Services at 888-243-3312 or email CCHPProviderRelations@cookchildrens.org.

Procedure Code

Code Description Added, Terminated, Revised

Effective Date of Change

STAR

CHIP

STAR Kids C9152 PR INJ, ABILIFY ASIMTUFII, 1 MG Terminated 1/1/2024 X X X C9153 PR INJ, AMISULPRIDE, 1 MG Terminated 1/1/2024 X X X C9154 PR INJ BUPRENORPH (BRIXADI) 1MG Terminated 1/1/2024 X X X C9155 PR INJ EPCORITAMAB-BYSP,0.16 MG Terminated 1/1/2024 X X X C9157 PR INJ, TOFERSEN, 1 MG Terminated 1/1/2024 X X X C9158 PR INJ, UZEDY, 1 MG Terminated 1/1/2024 X X X 81361 CHG HBB COMMON VARIANTS Revised 1/15/24 X X X 81257 CHG HBA1/HBA2 GENE ANALYSIS COMMON DELETIONS/VARIANT Revised 1/15/24 X X X J1304 INJ TOFERSEN INTRATHEC 1 MG Added 1/1/2024 X X X L5926 PR ENDOSKEL POSIT ROTAT UNIT Added 1/1/2024 X X X J0576 INJ BUPRENORPH (BRIXADI) 1MG Added 1/1/2024 X X X J1413 DELANDISTROGENE MOXEPARVOVEC (ELEVIDYS) Added 1/1/2024 X X X J0402 INJ, ABILIFY ASIMTUFII, 1 MG Added 1/1/2024 X X X J2799 INJ, UZEDY, 1 MG Added 1/1/2024 X X X 75580 CHG N-INVAS EST C FFR AUGMNT SW ALYS CTA I&R PHY/QHP Added 1/1/2024 X X X

022624

E0733 TRANS ELEC NERV FOR TRIGEMIN Added 1/1/2024 X X X 27278 ARTHRD SI JT PRQ W/PLMT IARTIC IMPLT WO TFXJ DEV Added 1/1/2024 X X X L3161 FOOT, ADDUCTUS POSITION, ADJ Added 1/1/2024 X X X 93150 THER ACTIVATION IMPL PHRENIC NRV STIMULATOR SYS Added 1/1/2024 X X X J9333 INJ RONZANOLIXIZUM-NOLI 1 MG Added 1/1/2024 X X X J9334 INJ EFGART-ALFA 2MG HYA-QVFC Added 1/1/2024 X X X

Book a walkthrough

Walk through this policy with us

Review how this policy can be converted into cited criteria, prior authorization checks, and operational automation.