What insurance policy changes affect HCPCS J1745?

There are 12 tracked policy changes affecting HCPCS J1745, including updates from Medica, BCBS Tennessee, Florida Blue. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J1745?

Payers that have issued tracked updates for HCPCS J1745 include: Medica, BCBS Tennessee, Florida Blue, Arkansas Blue Cross Blue Shield, Blue Cross Blue Shield of North Dakota, Humana, Harvard Pilgrim Health Care.

How do I get notified when HCPCS J1745 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J1745. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS J1745?

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.

J1745 — Injection, infliximab, excludes biosimilar, 10 mg: Insurance Policy Changes

J1745 Insurance Policy Changes

HCPCS J1745 is officially defined as "Injection, infliximab, excludes biosimilar, 10 mg." HCPCS J1745 is referenced in 12 tracked payer policy changes from Medica, BCBS Tennessee, and 5 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J1745 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Policy Criteria Change

Arkansas Blue Cross Blue Shield·Effective Apr 1, 2026

Effective April 1, 2026, Walmart insurance will require prior authorization for all Bevacizumab, Infliximab, and Rituximab products (brand and biosimilars) across oncologic and non-oncologic indications. The policy establishes preferred biosimilar products (Mvasi, Zirabev, Avsola, Inflectra, Truxima, Riabni) that must be requested first, with non-preferred products (including Avastin, Remicade, Rituxan) requiring documented adverse events and FDA MedWatch reporting for exceptions.

J1745 Insurance Policy Changes

Medica Provider News: May 2026

Commercial BlueCare PAD_Step Therapy Guide

New Drug Waste Reduction Guideline

Medicare Part B Step Therapy May Updates

Policy Criteria Change

Medicare Part B Step Therapy Product Updates

Medical Drug Preferred Product Updates for December 1, 2025

Non-Preferred Infliximab Products - Renflexis (infliximab-abda), Avsola (infliximab-axxq), Remicade (infliximab), unbranded Infliximab (Revised)

Coverage changes for Remicade and biosimilars

Coverage changes for Remicade and biosimilars

Preferred Infliximab Products - Inflectra (infliximab-dyyb) (Revised)

Preferred Infliximab Products - Inflectra (infliximab-dyyb) (Revised)