G0138, Intravenous infusion of cipaglucosidase alfa-atga, including provider/supplier
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.21
Facility
$196.40
Non-Facility
$196.40
Key Coverage Criteria
- Taliglucerase alfa (Elelyso) is covered for individuals ≥4 years with confirmed Type 1 Gaucher disease.
- Velaglucerase alpha (VPRIV) is covered for long-term ERT in individuals ≥4 years with Type 1 Gaucher disease.
- Vestronidase alfa-vjbk (Mepsevii) is covered for individuals with MPS VII (Sly syndrome).
- Agalsidase beta (Fabrazyme) is covered when the member is ≥2 years old and has a confirmed diagnosis of Fabry disease.
- Avalglucosidase alfa-NGPT (Nexviazyme) is covered for individuals ≥1 year with late-onset Pompe disease (GAA deficiency).
- Idursulfase (Elaprase) is covered for individuals ≥5 years with a diagnosis of Hunter's syndrome (MPS II).
4 Active Policies
BCBSIL-RX501.067, Enzyme-Replacement Therapy for Lysosomal Storage Disorders
BCBSMT-RX501.067, Enzyme-Replacement Therapy for Lysosomal Storage Disorders
BCBSNM-RX501.067, Enzyme-Replacement Therapy for Lysosomal Storage Disorders
BCBSOK-RX501.067, Enzyme-Replacement Therapy for Lysosomal Storage Disorders
Related Codes
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