J0606, Injection, etelcalcetide, 0.1 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Initiate Parsabiv (etelcalcetide) for treatment of secondary hyperparathyroidism due to CKD in patients on dialysis, not on Parsabiv with cinacalcet, prescribed by endocrinologist or nephrologist, dosing per FDA labeling, with initial authorization up to 12 months.
- Initial Therapy: Parsabiv (etelcalcetide) is proven for the treatment of secondary hyperparathyroidism with chronic kidney disease when the following criteria are met: diagnosis of secondary hyperparathyroidism with CKD; patient on dialysis; not receiving Parsabiv in combination with Sensipar; prescribed by or in consultation with an endocrinologist or nephrologist; dosing in accordance with FDA labeling; initial authorization no longer than 12 months.
- Parsabiv (etelcalcetide) is approved for initial therapy in adults with secondary hyperparathyroidism due to CKD on dialysis, provided: (1) diagnosis of secondary hyperparathyroidism with CKD; (2) patient is on dialysis; (3) not on Parsabiv with cinacalcet; (4) prescribed by or consulted with endocrinologist or nephrologist; (5) dosing per FDA labeling; (6) initial authorization up to 12 months.
3 Active Policies
UMR-POL-UMR-parsabiv-etelcalcetide, Parsabiv (Etelcalcetide)
SUREST-POL-SUREST-parsabiv-etelcalcetide, Parsabiv (Etelcalcetide)
UHC-POL-parsabiv-etelcalcetide, Parsabiv (Etelcalcetide)
Related Codes
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