J3247 — Injection, secukinumab, intravenous, 1 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Justification why IV route is medically reasonable and necessary (explicit explanation required in request).
- Prescriber attestation that patient or caregiver cannot be trained or are physically unable to administer the FDA‑labeled self‑administered (subcutaneous) Cosentyx, plus supporting medical records and/or justification explanation.
- For prior targeted immunomodulator use: documentation of drug name, dates of therapy, and duration (claims history or medical records).
- For prior methotrexate trial (PsA initial therapy): documentation of 3‑month trial at maximally indicated dose or documentation of contraindication/intolerance.
Key Coverage Criteria
- Intravenous Cosentyx (secukinumab) for administration by a healthcare professional is medically necessary for adult patients with active psoriatic arthritis (PsA) when all applicable criteria below are met.
- For initial PsA therapy: diagnosis of active psoriatic arthritis; Cosentyx is initiated and titrated according to U.S. FDA‑labeled dosing for PsA; patient is not receiving Cosentyx in combination with a targeted immunomodulator (examples listed in policy); prescribed by or in consultation with a rheumatologist or dermatologist; initial authorization issued for 12 months.
- For initial PsA therapy — additional prerequisites (one of the following must be met): history of failure to a 3‑month trial of methotrexate at the maximally indicated dose unless contraindicated or intolerant; OR prior treatment with a targeted immunomodulator FDA‑approved for PsA (document drug, date, duration).
- For PsA continuation of therapy: documentation of positive clinical response; Cosentyx continued per FDA‑labeled dosing for PsA; patient is not receiving Cosentyx in combination with a targeted immunomodulator; authorization issued for 12 months.
- Intravenous Cosentyx is medically necessary for adult patients with active ankylosing spondylitis (AS) or non‑radiographic axial spondyloarthritis (nr‑axSpA) when all applicable criteria below are met.
- For initial AS / nr‑axSpA therapy: diagnosis of active ankylosing spondylitis or non‑radiographic axial spondyloarthritis; Cosentyx is initiated and titrated according to U.S. FDA‑labeled dosing for AS or nr‑axSpA; patient is not receiving Cosentyx in combination with a targeted immunomodulator (examples listed in policy); prescribed by or in consultation with a rheumatologist; initial authorization issued for 12 months.
14 Active Policies
UHC-POL-cosentyx — Cosentyx (Secukinumab)
UHC-POL-provider-administered-drugs-soc — Provider Administered Drugs – Site of Care
UMR-POL-UMR-cosentyx — Cosentyx (Secukinumab)
UMR-POL-UMR-provider-administered-drugs-soc — Provider Administered Drugs – Site of Care
SUREST-POL-SUREST-cosentyx — Cosentyx (Secukinumab)
Related Codes
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