What insurance policy changes affect HCPCS J1602?

There are 10 tracked policy changes affecting HCPCS J1602, including updates from Arkansas Blue Cross Blue Shield, BCBS Tennessee, Florida Blue. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J1602?

Payers that have issued tracked updates for HCPCS J1602 include: Arkansas Blue Cross Blue Shield, BCBS Tennessee, Florida Blue, Humana, Indiana Medicaid (IHCP), Aetna.

How do I get notified when HCPCS J1602 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J1602. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS J1602?

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.

J1602 — Injection, golimumab, 1 mg, for intravenous use: Insurance Policy Changes

J1602 Insurance Policy Changes

HCPCS J1602 is officially defined as "Injection, golimumab, 1 mg, for intravenous use." HCPCS J1602 is referenced in 10 tracked payer policy changes from Arkansas Blue Cross Blue Shield, BCBS Tennessee, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J1602 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

Medium impact

Gamifant® (emapalumab-lzsg) (Revised)

Humana·Effective Nov 1, 2025

This is a revised Gamifant (emapalumab-lzsg) prior authorization policy for Ohio Medicaid effective November 1, 2025, with a revision date of June 24, 2026. The policy establishes coverage criteria for two distinct indications: primary HLH requiring documented gene mutation or 5+ clinical characteristics plus failed conventional therapy and stem cell transplant candidacy, and HLH/MAS in Still's disease requiring inadequate response to glucocorticoids or recurrent MAS. All approvals require concurrent dexamethasone administration and carry 6-month initial and renewal periods.

J1602 Insurance Policy Changes

Policy Criteria Change

Commercial BlueCare PAD_Step Therapy Guide

New Drug Waste Reduction Guideline

Medicare Part B Step Therapy May Updates

Xgeva® (denosumab) and biosimilars (New)

Simponi (golimumab) (Revised)

BT2025154: IHCP updates PA requirements for certain physician-administered drugs

Intradiscal Procedures (CPB 0602, reviewed 2025-09-10)

Gamifant® (emapalumab-lzsg) (Revised)

Simponi ARIA (golimumab) (Revised)