C9142 Inj, alymsys, 10 mg

Injection, bevacizumab-maly, biosimilar, (alymsys), 10 mg

Payer policies and prior authorization for C9142

1 of 1 payer prior-auth lists that name C9142 require prior authorization or set conditions: Blue Cross and Blue Shield of Texas.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross and Blue Shield of TexasTexas PA exemption (gold card), outpatient, fully insuredTXprior auth requiredGold-card exemption availableJul 1, 2026BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)

Payer coverage policies that name C9142

C9142 appears in 3 coverage policies from Aetna, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Wellmark Blue Cross Blue Shield.

PayerPolicyRole in policyReviewedDocument
AetnaInjectable Medications (0020)listed, no stance (range C8957-C9235)Mar 5, 2026payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)Oncology and Supportive Care Medications (RX502.061)
Code | Generic | Brand		listed, no stanceJan 1, 2027payer document
Wellmark Blue Cross Blue ShieldBevacizumab (05.04.24)listed, no stanceAug 1, 2026payer document

Recent prior-auth changes

  • Jun 1, 2023: PA removed, Blue Shield of California Promise Health Plan
  • Dec 15, 2022: PA added, Blue Shield of California Promise Health Plan

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.