J9038, Injection, axatilimab-csfr, 0.1 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
- Documentation/authorization requirement: Authorization will be issued for no more than 12 months.
Key Coverage Criteria
- Covered indication: Niktimvo (axatilimab-csfr) is medically necessary for treatment of chronic graft-versus-host disease (cGVHD) in patients who have failed at least two prior lines of systemic therapy and meet all initial-therapy criteria (diagnosis of cGVHD per NIH criteria, history of failure with corticosteroids and another specified agent, patient weight ≥40 kg, prescribed by/consulted with transplant specialist, dosing per FDA-labeled indication, and authorization for up to 12 months).
3 Active Policies
UHC-POL-niktimvo, Niktimvo (Axatilimab-Csfr)
UMR-POL-UMR-niktimvo, Niktimvo (Axatilimab-Csfr)
SUREST-POL-SUREST-niktimvo, Niktimvo (Axatilimab-Csfr)
Related Codes
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