Topic

Texas

A collection of 237 issues

Coding That Helps Get Haegarda Covered by UnitedHealthcare in Texas: ICD-10, J-Code, and NDC Requirements

Answer Box: Getting Haegarda Covered by UnitedHealthcare in Texas Fastest Path: Submit prior authorization with ICD-10 code D84.1 (hereditary angioedema), specialist documentation, and lab evidence of C1-INH deficiency. Use J-code J0599 for billing (10 units per code). UnitedHealthcare requires specialist prescriber and confirmed HAE diagnosis—no absolute step therapy

How to Get Krystexxa (Pegloticase) Covered by Blue Cross Blue Shield of Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Krystexxa Approved by BCBS Texas Blue Cross Blue Shield of Texas requires prior authorization for Krystexxa (pegloticase) with specific clinical criteria: documented refractory gout, failed trials of allopurinol and febuxostat, persistent serum uric acid ≥6 mg/dL, and normal G6PD testing. Submit through the Availity Authorization portal

Getting Pombiliti Covered by Blue Cross Blue Shield of Texas: Prior Authorization, Appeals & Financial Assistance Guide

Answer Box: How to Get Pombiliti Covered by Blue Cross Blue Shield of Texas Pombiliti (cipaglucosidase alfa-atga) is not on the 2024 BCBS Texas formulary, requiring a prior authorization or formulary exception. Your fastest path to coverage: (1) Have your specialist submit a detailed prior authorization request with documented Pompe

Myths vs. Facts: Getting Rebif (interferon beta-1a) Covered by Aetna (CVS Health) in Texas

Answer Box: Getting Rebif Covered by Aetna in Texas Myth: If your doctor prescribes Rebif, Aetna automatically covers it. Fact: Prior authorization is required, and coverage depends on meeting specific medical necessity criteria and formulary requirements. The fastest path: Have your neurologist submit a complete PA request with MS diagnosis,

How to Get Orladeyo (Berotralstat) Covered by Humana in Texas: Appeals, Forms, and State Protections

Quick Answer: Getting Orladeyo Covered by Humana in Texas Orladeyo (berotralstat) requires prior authorization from Humana in Texas. The fastest path to approval involves: (1) having your HAE specialist submit a comprehensive PA request with C1-INH testing, prior therapy documentation, and medical necessity letter, (2) using Humana's electronic

Get Mavenclad (Cladribine Tablets) Covered by UnitedHealthcare in Texas: Complete Prior Authorization and Appeals Guide

Answer Box: Getting Mavenclad Covered by UnitedHealthcare in Texas Yes, Mavenclad (cladribine tablets) is covered by UnitedHealthcare in Texas, but requires prior authorization through OptumRx and step therapy documentation. Your neurologist must prove you've tried and failed (or can't tolerate) at least one other MS disease-modifying

Getting Chenodal (Chenodiol) Covered by Cigna in Texas: Complete PA Guide with Appeals Process

Answer Box: To get Chenodal (chenodiol) covered by Cigna in Texas, you'll need prior authorization with documented failure of ursodiol (6+ months), imaging showing radiolucent gallstones, and surgical ineligibility. Your gastroenterologist submits the PA through Accredo specialty pharmacy, not retail. Standard review takes 72 hours; expedited review (for

Getting StrataGraft Covered by Aetna CVS Health in Texas: Prior Authorization, Appeals & Cost-Saving Strategies

Answer Box: Getting StrataGraft Covered by Aetna CVS Health in Texas StrataGraft requires prior authorization through Aetna's medical benefit (not pharmacy) for adults with deep partial-thickness thermal burns. The fastest path: 1) Confirm your burn meets FDA criteria with your physician, 2) Submit prior authorization with complete medical

How to Renew Epidiolex (Cannabidiol) Coverage with Aetna CVS Health in Texas: Timeline, Forms, and Emergency Appeal Process

Answer Box: Renewing Epidiolex (Cannabidiol) with Aetna CVS Health in Texas Submit renewal requests at least 30 days before your current authorization expires. Aetna CVS Health requires updated medical necessity documentation, recent liver function tests, and seizure frequency records. Standard decisions take 7 days; expedited reviews complete within 72 hours

Coding That Helps Get Amondys 45 (casimersen) Covered by Cigna in Texas: ICD-10, HCPCS J-Code, and NDC Guide

Answer Box: Get Amondys 45 Covered by Cigna in Texas Getting Amondys 45 (casimersen) covered by Cigna requires precise coding and documentation. Use ICD-10 code G71.01 for Duchenne muscular dystrophy, bill under HCPCS J1426 (1 unit = 10 mg), and include genetic testing confirming exon 45 mutation amenability. Submit through