Medical Policy Implementation: Etelcalcetide (Parsabiv)
Effective May 21, 2018, Horizon Blue Cross Blue Shield of New Jersey will change the way we consider certain professional claims for intravenous drug Parsabiv™.
We encourage you to visit our Medical Policy Manual to review the guidelines of our Etelcalcetide (Parsabiv) medical policy which identify when the use of this drug is considered medically necessary.
Based on the guidelines of our medical policy, Etelcalcetide (Parsabiv), claims for services provided on and after May 21, 2018 will be processed as noted below.
- Claims that include HCPCS code J0606 for patients 18 years of age and older may pend, based on the submitted diagnosis code(s), while information to help us determine if the drug in question is considered medically necessary is requested and reviewed.
- HCPCS code J0606 included on claims for patients under age 18 will be denied as an experimental/investigative service regardless of the submitted diagnosis code(s).
Unless Horizon BCBSNJ gives written notice that all or part of the above changes have been cancelled or postponed, the changes will be applied to claims for dates of service on and after May 21, 2018.
Parsabiv™ is a registered trademark of 2018 Amgen Inc.