J0742, Injection, imipenem 4 mg, cilastatin 4 mg and relebactam 2 mg
HCPCS/CPT
Prior Authorization
Prior Auth Required
Conditional coverage; review criteria to confirm PA need (medium confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
2 Active Policies
BCBSMS-L-5-01-548-5FF748240D, Recarbrio (imipenem-cilastatin-relebactam)
MS
BCBSMS-S-5-01-548-9906536881, State and School Employees' Health Insurance Plan - Recarbrio (imipenem-cliastatin-relebactam)
MS
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