AzCH-CCP Cyclophosphamide Code Changes, eff. 5/01/2025

Date: 04/01/25

Arizona Complete Health-Complete Care Plan (AZCH-CCP) requires prior authorization (PA) as a condition of payment for certain services.

It is the ordering/prescribing/referring provider’s responsibility to the AZCH-CCP Pre-Auth Check Tool to determine when a PA is required. Also, providers should verify eligibility and benefits prior to rendering services for members. Payment, regardless of PA, is contingent on the member’s eligibility at the time the service is rendered.

To confirm if a CPT/HCPCS code requires PA, please use the Pre-Auth Check Tool on our website www.azcompletehealth.com > For Providers > Pre-Auth Check.

Effective 5/1/2025, the following changes will be effective:

Service Category	Procedure Code	Procedure Code Description	PA Rule	Additional Requirements/Notes
Bio-pharmacy (In-office Injectable	J9071	Injection, cyclophosphamide (auromedics), 5 mg	PA required for non-par providers only	For oncology, please submit to Evolent
Bio-pharmacy (In-office Injectable	J9072	Injection, cyclophosphamide (avyxa), 5 mg	PA required for all providers	For oncology, please submit to Evolent
Bio-pharmacy (In-office Injectable	J9073	Injection, cyclophosphamide (ingenus), 5 mg	PA required for non-par providers only	For oncology, please submit to Evolent
Bio-pharmacy (In-office Injectable	J9074	Injection, cyclophosphamide (sandox), 5 mg	PA required for all providers	For oncology, please submit to Evolent
Bio-pharmacy (In-office Injectable	J9075	Injection, cyclophosphamide 5mg, not otherwise specified.	PA required for non-par providers only	For oncology, please submit to Evolent
Bio-pharmacy (In-office Injectable	J9076	Injection, cyclophosphamide (baxter), 5 mg	PA required for all providers	For oncology, please submit to Evolent

If you have questions, please contact the pharmacy team (888) 788-4408 (Options 3, 7).

 

Thank you!