Chronic hepatitis B (including hepatitis D virus co-infection) virus infection or.Chronic hepatitis C virus infection or.Renal cell carcinoma (RCC) when the requested medication will be used in combination with bevacizumab or.Follicular lymphoma (clinically aggressive) or.Mycosis fungoides (MF)/Sezary syndrome (SS) or.Adult T-cell leukemia/lymphoma (ATLL) when the requested medication is used in combination with zidovudine or.
Interferon alfa-2b (Intron A)Īetna considers interferon alfa-2b (Intron A) medically necessary for the following indications: Precertification of interferon beta-1a (Avonex) is required of all Aetna participating providers and members in applicable plan designs. For precertification of interferon beta-1a (Avonex), call (866) 752-7021 (commercial), or fax (888) 267-3277. Number: 0404 Table Of Contents Policy Applicable CPT / HCPCS / ICD-10 Codes Background References
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