CommercialPrior AuthMedium impact
State and School Employees' Health Insurance Plan - Fetroja (cefiderocol sulfate tosylate)
Blue Cross & Blue Shield of Mississippi·MS · Infectious Disease, Critical Care, Internal Medicine +3 more·Medical Policy
Effective date
Jan 31, 2025
We identified it
Jun 20, 2026
Summary
Blue Cross Blue Shield of Mississippi created a new medical policy for Fetroja (cefiderocol), an IV antibiotic for complicated UTIs and hospital-acquired pneumonia. The policy requires strict criteria including culture/sensitivity testing, age >18, and limited treatment alternatives, with approval limited to 14 days.
Action Required
Immediately: Billing team must update system to require prior authorization for HCPCS code J0699 (cefiderocol injection) for Mississippi State and School Employee Health Plan members. Ensure providers document culture/sensitivity testing, patient age >18, specific qualifying diagnoses (complicated UTI/pyelonephritis or hospital-acquired/ventilator-associated pneumonia), and limited treatment alternatives. Claims without proper documentation will be denied.