INTERPRETIVE OR POLICY STATEMENT
Legal and Administrative Services
Subject: The medicaid program of the health care authority (the agency) will change the coverage status of Benlysta¦ when administered in an outpatient hospital setting.
Effective Date: April 1, 2012.
Description: Effective for dates of service on and after April 1, 2012, the medicaid program of the agency will change the coverage status of Benlysta¦ when administered in an outpatient hospital setting from noncovered to covered with prior authorization. See table below for procedure code and coverage status [no further information supplied by agency].
For additional information, contact Amber Dassow, HCA, P.O. Box 45504, phone (360) 725-1349, TDD/TTY 1-800-848-5429, fax (360) 586-9727, e-mail firstname.lastname@example.org, web site http://www.hca.wa.gov/.