Oncology medication prior review and authorized HCPCS/J-codes list
This document governs authorization/review requirements for oncology medications and supportive agents for Fidelis Care Medicaid Managed Care & HealthierLife members and lists HCPCS/J-codes requiring prior review; it affects pharmacies and providers administering oncology drugs.
No material clinical or coverage changes in this revision.
Authorization and Coverage Criteria
Authorization and code-list criteria
Prior review by Evolent (New Century Health) is required for oncology medications and supportive agents; an extensive list of HCPCS/J- and Q-codes in the policy requires authorization.
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