Priority Health: Beovu Payer Policy

Created by C. Denise Burrell, Modified on Wed, 8 Jan at 5:58 PM by C. Denise Burrell

Priority Health: Beovu Payer Policy (Beta Access)

TABLE OF CONTENTS


 MEDICARE PART B


HCPCS Code(s):J0179
Precertification Required?Dependent
Step Therapy Required?Not Specified
Provider Fax Form:Medicare Part B Medical Drug Request(✅ Available in SamaCare)
FDA Approved Indications:

Not Specified

Recommended Dosage:

Not Specified


No PA required when billed for the following ICD-10 code:
H35.3210-H35.3213, H35.3220-H32.3223, H35.3230-H35.3233, H35.3290-H35.3293 
All other ICD-10 diagnoses: PA required



Sources: 

https://priorityhealth.stylelabs.cloud/api/public/content/Medical_Benefit_Drug_List_downloadOriginal?v=ebe3fbe9



MEDICAID


HCPCS Code(s):J0179
Precertification Required?Dependent
Step Therapy Required?Not Specified
Provider Fax Form:Medicaid Medical Drug Request (✅ Available in SamaCare)
FDA Approved Indications:

Not Specified

Recommended Dosage:

Not Specified


No PA required when billed for the following ICD-10 code:
H35.3210-H35.3213, H35.3220-H32.3223, H35.3230-H35.3233, H35.3290-H35.3293



Sources:

https://priorityhealth.stylelabs.cloud/api/public/content/Medical_Benefit_Drug_List_downloadOriginal?v=ebe3fbe9




COMMERCIAL

HCPCS Code(s):J0179
Precertification Required?Dependent
Step Therapy Required?Not Specified
Provider Fax Form: Commercial Medical Drug Request (✅ Available in SamaCare)
FDA Approved Indications:Not Specified
Recommended Dosage:Not Specified


No PA required when billed for the following ICD-10 code:
 H35.3210-H35.3213, H35.3220-H32.3223, H35.3230-H35.3233, H35.3290-H35.3293


Sources:

https://priorityhealth.stylelabs.cloud/api/public/content/Medical_Benefit_Drug_List_downloadOriginal?v=ebe3fbe9

⚠️ Disclaimer: This article is a policy summary and does not guarantee coverage or approval. 

Policies may vary based on plan, payer-specific rules, state or regional requirements, benefit structure, formulary placement, and patient-specific considerations like diagnosis or clinical history. Always review the full policy and confirm details directly with the payer to ensure compliance. 


 

We're here to guide you through your prior authorization quest!







Was this article helpful?

That’s Great!

Thank you for your feedback

Sorry! We couldn't be helpful

Thank you for your feedback

Let us know how can we improve this article!

Select at least one of the reasons
CAPTCHA verification is required.

Feedback sent

We appreciate your effort and will try to fix the article