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HCPCS/CPT J1190, Injection, dexrazoxane hydrochloride, per 250 mg | Prior Auth Required

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`J1190`, Injection, dexrazoxane hydrochloride, per 250 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

1 Active Policy

HEALTHNET_OR-HNOR-DEXRAZOXANE-TOTECT-CP-PHAR-418-C65090FD21, Dexrazoxane (Totect); CP.PHAR.418

OR

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