Limited Use Note(s) |
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APIXABAN2.5mg Tab
Reason For Use Code | Clinical Criteria |
---|---|
433 | For the prevention of venous thromboembolic events in patients who have undergone elective total knee replacement (TKR) surgery. Note: Limited to 14 days of reimbursement in TKR. Limited to 1 claim in a 120 day period. |
LU Authorization Period: 1 year | |
434 | For the prevention of venous thromboembolic events in patients who have undergone elective total hip replacement (THR). Note: Limited to 35 days of reimbursement in THR. Limited to 1 claim in a 120 day period. |
LU Authorization Period: 1 year |