Mirikizumab-mrkz (Omvoh) coverage
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Defines Meridian Health Plan's clinical policy guidance for medical necessity and coding implications related to mirikizumab-mrkz (Omvoh) for applicable members and providers.
No material clinical or coverage changes in this revision.
Coverage Criteria
For members covered by Medicaid, state Medicaid coverage provisions take precedence when there is a conflict between those state provisions and the coverage provisions in this clinical policy. Providers and reviewers should consult the applicable state Medicaid manual for any state-specific coverage rules that apply to this therapy.
Coding
| J2267 | Injection, mirikizumab-mrkz, 1 mg |
Provider Actions & Billing Guidance
Billing code (informational)
Claims for mirikizumab-mrkz (Omvoh) may be billed using HCPCS code J2267 (Injection, mirikizumab-mrkz, 1 mg); inclusion of the code in this policy is informational and does not itself guarantee coverage or remove prior authorization requirements.
Provider / billing note
Include the HCPCS code on claims as appropriate and ensure claim lines accurately reflect the administered product and dose.
- Use J2267 to indicate mirikizumab-mrkz when billing if applicable.
Reference current professional coding guidance
Providers should reference the most up-to-date sources of professional coding guidance prior to submission of claims for reimbursement.
Coding inclusion/exclusion warning
Inclusion or exclusion of any codes in this policy does not guarantee coverage; providers must verify current coding guidance and coverage requirements before claim submission.
Definitions
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