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CIGNAs pharmacy coverage position on leuprolide (Lupron, Lupron ...

C IGNA M EDICAL C OVERAGE P OLICY The following Coverage Policy applies to all plans administered by CIGNA Companies including plans administered by Great-West ...

http://www.cigna.com/customer_care/healthcare_professional/coverage_positions/pharmacy/ph_6117_coveragepositioncriteria_leuprolide.pdf

Rx only

1 LUPRON INJECTION (leuprolide acetate) Rx only DESCRIPTION Leuprolide acetate is a synthetic nonapeptide analog of naturally occurring gonadotropin releasing hormone (GnRH or ...

http://pitap.abbott.com/LUPRONINJECTION.PDF

Provider Administered Injectable Drug Program Quick Reference Guide

... must be authorized by ICORE before being administered in the office: Table 1 J-Code ... Intron-A Supprelin LA Lupron Depot Synagis Neumega Tysabri Nplate ...

https://specialtydrug.magellanprovider.com/MHS/Sdrug/content/PDFs/avmedQRG.pdf

Health Choice of Arizona PRIOR AUTHORIZATION GUIDELINES

Prior Authorization Guidelines Last update: June, 2010 Page 1 Health Choice of Arizona PRIOR AUTHORIZATION GUIDELINES It is with great pleasure that Health Choice provides ...

http://www.healthchoiceaz.com/generalproviders/Documents/ProviderManual/Chapter6-Authorizations/Exhibit%206-1%20Health%20Choice%20Arizona%20Prior%20Authorization%20Requirements.pdf

National Drug Code (NDC) Billing Reference

NDC Billing Reference for Nevada Medicaid and Nevada Check Up Claims 09/16/08 Page 1 National Drug Code (NDC) Billing Reference (for Nevada Medicaid and Nevada Check Up ...

http://www.sentryds.com/wp-content/uploads/nv_dra.pdf

MORTAR MIXER

Page 2 SKU 95906 For technical questions, please call 1-800-444-3353. sPECIFICATIOns Drum Capacity 6 Cubic Feet Batch Capacity 1-1/2 to 2 Bags of cement Wheel to ...

http://www.harborfreight.com/manuals/95000-95999/95906.pdf

Understanding Specialty Pharmacy Management and Cost Control JUNE 2010

... IVchemotherapyandsupportiveagents,anddepotinjectionsofLupronor ... HCPCS J or Q Code specific to drug or drug class but not specific to ...

http://www.psgconsults.com/Understanding_Specialty_Pharmacy_Management_and_Cost_Control_FINAL.pdf

Medicare Reimbursement for Lupron (OEI-03-03-00250; 01/04)

In 2002, Medicare and its beneficiaries paid $677 million for Lupron (7.5 mg depot suspension), accounting for 8 percent of all Medicare drug reimbursement that year.

http://oig.hhs.gov/oei/reports/oei-03-03-00250.pdf

Clinical Coverage Guideline

... inability to tolerate leuprolide acetate (Lupron Depot Ped ... sterile fluid collect ions at the sites of injections ... Covered ICD-9-CM Diagnosis Code. 259.1 Precocious ...

https://www.wellcare.com/WCAssets/corporate/assets/HS020_Supprelin.pdf

Policy Name Self-Administered Drugs

... joints), intrathecal injections, limited subcutaneous injections ... 07/01/2009 Updated codes 06/01/2009 Removed Lupron Depot, added Affinitor to code list 06/01 ...

https://provider.medica.com/C14/ClaimPolicies/Document%20Library/Self_Administered_Drugs_Claims_Policy.pdf

BCBSM and BCN Medical Specialty Product List

hcpcs code description product 90371 hep b ig, im bayhep b or nahi-hb 90375 rabies ig ... refludan 50mg vial j1950 leuprolide acetate lupron depot or lupron depot-ped j1955 ...

http://www.bcbsm.com/pdf/specprodlist.pdf

National Drug Code (NDC) Billing Reference

NDC Billing Reference for Nevada Medicaid and Nevada Check Up Claims Updated nl 07/14/10 pv 09/16/08 Page 1 National Drug Code (NDC) Billing Reference (for Nevada Medicaid and ...

https://nevada.fhsc.com/downloads/provider/nv_billing_ndc_reference.pdf

HMO Blue Specialty Injectable Drug Program - J-Code Drug Name Discount

j-code drug name discount j0476 lioresal intrathecal awp ... awp- 16% j1830 betaseron awp- 15% j1950 lupron awp- 15% ... nutropin depot saizen serostim awp- 15% j3240 thyrogen ...

http://www.bcbstx.com/provider/pdf/jcode_and_awp_discount_list.pdf

Clinical Coverage Guideline

Supprelin LA (histrelin acetate) Subcutaneous Implant for the Treatment of Central Precocious Puberty (CPP)

http://www.wellcare.com/WCAssets/corporate/assets/HS020_Supprelin.pdf

Title: Health Plan Providers: Therapeutic Injections and ...

Clearance #4942 Title: Health Plan Providers: Therapeutic Injections and Prescribed Drugs (To comment, please click inside the red box) OHIO DEPARTMENT OF JOB FAMILY ...

http://jfs.ohio.gov/OLS/clearance/public/4942.pdf

Medicare Reimbursement for Lupron (OEI-03-03-00250; 01/04)

Office of Inspector General http://oig.hhs.gov The mission of the Office of Inspector General (OIG), as mandated by Public Law 95-452, as amended, is to protect the ...

http://oig.hhs.gov/oei/reports/oei-03-03-00250.pdf

Health Choice of Arizona PRIOR AUTHORIZATION GUIDELINES

... the Pharmacy section of this guideline for injections ... with authorization: Medication description J Code ... FOR DEPOT SUSPENSION), 7.5 MG (ELIGARD/LUPRON DEPOT) J9217 ...

http://www.healthchoiceaz.com/generalproviders/Documents/ProviderManual/Chapter6-Authorizations/Exhibit%206-1%20Health%20Choice%20Arizona%20Prior%20Authorization%20Requirements.pdf

2012 J Code Prior Authorization List

2012 J Code Prior Authorization List www.lipa.net J Code DESCRIPTION LIPA J0129 Abatacept 10 mg IV Yes J0597 Berinert, 10u Yes J0598 Cinryze, 10u Yes

http://www.lipa.net/documents/providers/jcode_pa_list.pdf

Rx only

1 LUPRON INJECTION (leuprolide acetate) Rx only DESCRIPTION Leuprolide acetate is a synthetic nonapeptide analog of naturally occurring gonadotropin releasing hormone (GnRH or ...

http://pitap.abbott.com/LUPRONINJECTION.PDF

Power Bike

Power Bike By Earl Seidlinqer ASOLINE-powered engines have been popular with bicycle enthusiasts ever since such engines were made small enough to fit a bicycle frame.

http://countryplans.com/vintage_farm/bigkids/PowerBike.pdf

Clearance #4942 Title: Health Plan Providers: Therapeutic ...

Title: Health Plan Providers: Therapeutic Injections and ... (v) Lupron depot. (a) Lupron depot for the treament of ... made only when billed with an injection code (J code ...

http://jfs.ohio.gov/OLS/clearance/public/4942.pdf

Physicians Injectable Medications Fee Schedule (Update effective ...

new j code january 2012 : j1051 injection, medroxyprogesterone acetate, 50 mg (depo ... j9217 leuprolide acetate, for depot suspension, 7.5 mg (lupron : depot, eligard) ***men ...

http://portal.flmmis.com/FLPublic/Portals/0/StaticContent/Public/FEE%20SCHEDULES/2012_01_01_Physicians_Inject_Meds_Oncology_and_Oncology_Spt_Meds_v1.0.pdf

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