Q5131 Inj, idacio, 20 mgInjection, adalimumab-aacf (idacio), biosimilar, 20 mg
3 of 4 payer prior-auth lists that name Q5131 require prior authorization or set conditions: Molina Healthcare of Iowa, Molina Healthcare of Mississippi, UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth required | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 | |
| UnitedHealthcare Community Plan | KanCare | KS | prior auth required | Oct 1, 2026 | Prior authorization requirements for Kansas Medicaid Effective October 1, 2026 |
Q5131 appears in 7 coverage policies from Blue Cross & Blue Shield of Mississippi, Centene.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Blue Cross & Blue Shield of Mississippi | Antirheumatic Biologicals (L.5.01.404) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Biosimilar Medications (L.5.01.593) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Chronic Plaque Psoriasis (L.5.01.412) | covered if criteria are met | payer document | |
| Blue Cross & Blue Shield of Mississippi | Crohns Disease And Ulcerative Colitis (L.5.01.415) | listed, no stance | payer document | |
| Blue Cross & Blue Shield of Mississippi | Hidradenitis Suppurativa Hs (L.5.01.435) | covered if criteria are met | payer document | |
| Centene | Adalimumab (Humira), Adalimumab-afzb (Abrilada), Adalimumab-atto (Amjevita), Adalimumab-adbm (Cyltezo), Adalimumab- bwwd (Hadlima), Adalimumab-fkjp (Hulio), Adalimumab-adaz (Hyrimoz), Adalimumab-aacf (Idacio), Adalimumab-ryvk (Simlandi), Adalimumab-aaty (Yuflyma), Adalimumab-aqvh (Yusimry) (CP.PHAR.242) Reviews, Revisions, and Approvals | Date | P&T | covered if criteria are met | May 1, 2026 | payer document |
| Centene | Biologic and Non-biologic DMARDs (CP.CPA.194) Reviews, Revisions, and Approvals | Date | P&T | covered if criteria are met | May 1, 2026 | payer document |
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.