J0872, Injection, daptomycin (xellia), unrefrigerated, not therapeutically equivalent
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
3 Active Policies
BCBSMS-L-5-01-496-46CE6A44E2, Daptomycin
MS
BCBSMS-S-5-01-496-928760AE56, State and School Employees' Health Insurance Plan - Daptomycin
MS
HEALTHNET_OR-HNOR-DAPTOMYCIN-CUBICIN-RF-CP-PHAR-351-094C832799, Daptomycin (Cubicin RF); CP.PHAR.351
OR
Related Codes
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