HCPCS Code J0491: Injection, Anifrolumab‑fnia, 1 mg

Patients with active systemic lupus erythematosus or severe SLE who meet rheumatology classification criteria and have failed standard therapy or other biologic therapies are eligible. Patients with severe active lupus nephritis are not indicated for this therapy.

The intravenous dose is typically 300 mg per infusion. Providers calculate dose per patient weight and consider prior response to standard therapy or other biologic therapies.

Coverage under Medicare administrative contractor and Medicaid services requires documentation of medical necessity, prior therapy, and appropriate physician global assessment. Patient’s medical record must fully support the use of anifrolumab fnia.