Q2042, Tisagenlecleucel, up to 600 million car-positive viable t cells, including
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
- General requirement that documentation must support medical necessity per Medicare standards (medical records, clinical notes, diagnostic test results, treatment history) although no product-specific documentation items are listed in this document chunk.
- Documentation and clinical criteria referenced in the specific Humana Pharmacy Coverage Policies for Abecma, Aucatzyl, Breyanzi, and Carvykti should be provided when requesting coverage for those agents.
- No specific documentation requirements (medical records, test results, or clinical notes) are provided in the provided excerpt; the excerpt contains a 'Coding Information' heading but does not list required documentation. See full Humana policy for detailed documentation requirements.
- No documentation requirements are specified in this excerpt.
Key Coverage Criteria
- 38227 - Chimeric antigen receptor T cell (CAR T) therapy; receipt and preparation of CAR T cells for administration
- 38228 - Chimeric antigen receptor T cell (CAR T) therapy; CAR T cell
- Chimeric antigen receptor T-cell (CAR-T) therapy: harvesting of blood-derived T lymphocytes for development of genetically modified autologous CAR-T cells (CPT Category III code 0537T).
- Chimeric antigen receptor T-cell (CAR-T) therapy services as represented by listed CPT codes: 0538T (preparation of blood-derived T lymphocytes for transportation, e.g., cryopreservation, storage), 0539T (receipt and preparation of CAR-T cells for administration), and 0540T (CAR-T cell administration, autologous).
- Administration and supply of specific CAR-T products represented by listed HCPCS/Q-codes: Q2041 (Axicabtagene ciloleucel), Q2042 (Tisagenlecleucel), Q2053 (Brexucabtagene autoleucel), Q2054 (Lisocabtagene maraleucel), Q2055 (Idecabtagene vicleucel), Q2056 (Ciltacabtagene autoleucel), Q2058 (Obecabtagene autoleucel, per infusion), and C9301 (Obecabtagene autoleucel, up to 410 million CD19 CAR-positive viable T cells, per therapeutic dose).
- Use of not otherwise classified antineoplastic agents when billed to J9999 (as listed).
5 Active Policies
HUMANA-CHIMERIC-ANTIGEN-RECEPTOR-CAR-T-CELL-THERAPY-MA, Chimeric Antigen Receptor (CAR) T-cell Therapy
BCBSIL-RX502.061, Oncology Medications
BCBSMT-RX502.061, Oncology Medications
BCBSNM-RX502.061, Oncology Medications
BCBSOK-RX502.061, Oncology Medications
Related Codes
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