Plerixafor (CPB 0779, reviewed 2026-02-13)

By March 13, 2026: Billing and clinical teams must implement the following: (1) Update billing system rules to require documentation that plerixafor (J2562) is being administered ONLY after G-CSF, chemo-mobilization, or within a gene therapy protocol; (2) Implement a 4-day usage limit flag in claims processing to deny claims exceeding 4 consecutive days unless accompanied by stem cell harvest/apheresis documentation; (3) Update prior authorization templates to verify these three specific pathways before approval; (4) For any claim showing plerixafor use for indications listed as experimental (ALL, AML, CLL, CML, sickle cell, etc.), auto-deny with explanation of non-covered status; (5) Educate providers on CPT codes 38205, 38206, 38230, 38232, 38240, 38241 (stem cell harvesting procedures) and their required bundling with plerixafor claims; (6) Claims submitted without clear documentation of qualifying mobilization method will be denied. Front office staff should confirm indication at authorization stage.