J8612, Methotrexate (xatmep), oral, 2.5 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
3 Active Policies
BCBSLA-00602-B679814CAD, 00602 methotrexate oral solution (Xatmep, Jylamvo)
LA
POINT32HEALTH-PMNG-16396, Xatmep (methotrexate)
MULTI
HEALTHNET_OR-HNOR-METHOTREXATE-OTREXUP-RASUVO-REDITREX-XATMEP-JYLAMVO-CP-P-16F0E61072, Methotrexate (Otrexup, Rasuvo, Reditrex, Xatmep, Jylamvo); CP.PHAR.134
OR
Related Codes
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