HCPCS Level II › C codes C9311 Inj, eplontersen, 1 mgInjection, eplontersen, 1 mg (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Payer policies and prior authorization for C9311 19 of 19 payer prior-auth lists that name C9311 require prior authorization or set conditions: Aetna, CarePlus Health Plans, Cigna, Humana.
Payer Plan State Prior auth Conditions Since Source Aetna Medicare Advantage All prior auth required Oct 1, 2026 Participating provider precertification list for Aetna® Aetna Commercial All prior auth required Oct 1, 2026 Participating provider precertification list for Aetna® Cigna ACA/IFP All prior auth required Oct 1, 2026 Master Precertification List (For Health Care Providers) Cigna Basic Standard All prior auth required Oct 1, 2026 Master Precertification List (For Health Care Providers) Cigna Complete/PHS+/Preferred All prior auth required Oct 1, 2026 Master Precertification List (For Health Care Providers) CarePlus Health Plans CarePlus Health Plans FL prior auth required NDC required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List We have updated our CarePlus Health Plans Prior Authorization and Notification List for CarePlus Medi Humana Humana D-SNP (FL) FL prior auth required NDC required Jul 1, 2026 H1036-280 Humana Fully Integrated Florida prior authorization and notification list Humana Humana D-SNP (IL) IL prior auth required NDC required Jan 1, 2027 Humana Dual Fully Integrated Illinois prior authorization and notification list Humana Humana D-SNP (IN) IN prior auth required NDC required Jan 1, 2027 Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes: Humana Humana D-SNP (MI) MI prior auth required NDC required Oct 14, 2026 Humana Dual Integrated (health maintenance organization Dual Eligible Special Needs Plan (HMO D- SNP) Michigan prior authorization and notification list (PAL) Humana Humana D-SNP (SC) SC prior auth required NDC required Jul 1, 2026 Humana Dual Integrated South Carolina prior authorization and notification list Humana Humana D-SNP (VA) VA prior auth required NDC required Jul 1, 2026 Prior authorization and notification list Humana Dual Fully Integrated H2875-001 (Virginia) Humana Dual Fully Integrated H2875-003 (Virginia) Humana Humana Healthy Horizons KY prior auth required NDC required Oct 7, 2026 Humana Healthy Horizons in Kentucky Prior Authorization and Notification List Humana Humana Healthy Horizons LA prior auth required NDC required Oct 14, 2026 Humana Healthy Horizons in Louisiana Prior Authorization and Notification List Humana Humana Healthy Horizons OH prior auth required NDC required Oct 14, 2026 Humana Healthy Horizons in Ohio prior authorization and notification List Humana Humana Healthy Horizons OK prior auth required NDC required Oct 14, 2026 Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List Humana Humana Healthy Horizons SC prior auth required NDC required Oct 14, 2026 Humana Healthy Horizons in South Carolina prior authorization and notification list Humana Humana Healthy Horizons VA prior auth required NDC required Oct 14, 2026 Humana Healthy Horizons in Virginia professionally administered medication prior authorization and notification list Humana Humana MA and D-SNP All prior auth required NDC required Jan 1, 2027 Medicare Advantage and Dual Eligible Special Needs Plans prior authorization and notification list Important notes:
Payer coverage policies that name C9311 C9311 appears in 1 coverage policy from Premera Blue Cross.
Payer Policy Role in policy Reviewed Document Premera Blue Cross Pharmacologic Treatment of Transthyretin-Mediated Amyloidosis (5.01.593) listed, no stance Oct 1, 2026 payer document
Recent prior-auth changes Oct 14, 2026: PA added, Humana Oct 14, 2026: PA added, Humana Oct 14, 2026: PA added, Humana Oct 14, 2026: PA added, Humana Oct 14, 2026: PA added, Humana Oct 7, 2026: PA added, Humana Jul 1, 2026: PA added, CarePlus Health Plans Jul 1, 2026: PA added, Humana 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.