J2277, Injection, motixafortide, 0.25 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
Key Coverage Criteria
- Aphexda is indicated in combination with filgrastim (G-CSF [granulocyte-colony stimulating factor]) to mobilize hematopoietic stem cells to the peripheral blood for collection and subsequent autologous transplantation in patients with multiple myeloma.
3 Active Policies
HEALTHNET_OR-HNOR-MOTIXAFORTIDE-APHEXDA-CP-PHAR-655-8042DD003F, Motixafortide (Aphexda); CP.PHAR.655
OR
MODA-APHEXDA-38652D8180, Aphexda (motixafortide)
OR
BCBSTN-fcf11e7890, Motixafortide (Aphexda)
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