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PAYER POLICY CHANGES

J0607 Insurance Policy Changes

HCPCS J0607 is officially defined as "Lanthanum carbonate, oral, 5 mg (for esrd on dialysis)." HCPCS J0607 is referenced in 3 tracked payer policy changes from Aetna, Nevada Medicaid, and 1 other payer. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J0607 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Watch J0607

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REFERENCE DATA

Payers with rules8
Payers requiring prior auth8
  • Fidelis Care · Effective November 1, 2026

    Prior authorization required

    Fidelis Care Metal-Level Products authorization grid

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

  • Arizona Complete Health · Effective December 31, 2025

    Prior authorization required

    Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for J0607?

Ambetter lists J0607 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for J0607?

AmeriHealth Caritas lists J0607 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for J0607?

Arizona Complete Health lists J0607 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for J0607?

CalViva Health lists J0607 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does Centene require prior authorization for J0607?

Centene lists J0607 on Sunshine Health Title XIX, Title XXI, Managed Medical Assistance CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS J0607?

There are 3 tracked policy changes affecting HCPCS J0607, including updates from Aetna, Nevada Medicaid, Blue Cross and Blue Shield of Louisiana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J0607?

Payers that have issued tracked updates for HCPCS J0607 include: Aetna, Nevada Medicaid, Blue Cross and Blue Shield of Louisiana.

How do I get notified when HCPCS J0607 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J0607. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS J0607?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for J0607

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for J0607 in one place.

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