J2406, Injection, oritavancin (kimyrsa), 10 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-5-01-631-7C8BABC40E, Kimyrsa (oritavancin)
MS
BCBSMS-S-5-01-631-9B16FB1029, State and School Employees' Health Insurance Plan - Kimyrsa (oritavancin)
MS
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