Delaware Highmark to Require Prior Auth. for Eleven New Codes

December 2017 ~

Effective with dates of service of February 1st, 2018, and beyond, Highmark Blue Shield will require prior authorization for eleven procedure codes.

The following procedure codes will be added to Highmark’s List of Procedures/DME Requiring Authorization:

  • E0953 – Wheelchair accessory, lateral thigh or knee support, any type including fixed mounting hardware, each
  • E0954 – Wheelchair accessory, foot box, any type, includes attachment and mounting hardware, each foot
  • J1555 – Injection, immune globulin (Cuvitru), 100 mg
  • J1726 – Injection, Hydroxyprogesterone Caproate, (Makena), 10 mg
  • J1729 – Injection, Hydroxyprogesterone cCaproate, not otherwise specified, 10 mg
  • J2326 – Injection, Nusinersen, 0.1 mg (Spinraza)
  • J2350 – Injection, Ocrelizumab, 1 mg (Ocrevus)
  • J3358 – Ustekinumab, for intravenous injection, 1 mg (Stelara)
  • J9022 – Injection, Atezolizumab, 10 mg (Tecentriq)
  • J9023 – Injection, Avelumab, 10 mg (Bavencio)
  • Q2040 – Tisagenlecleucel, up to 250 million car-positive viable T cells, including Leukapheresis and dose preparation procedures, per infusion (Kymriah



Source(s): Highmark Blue Shield Provider Resource Center;