Limited Use Note(s) |
MIDAZOLAM5mg/mL Inj Sol (with Preservative)
Reason For Use Code | Clinical Criteria |
---|---|
495 | For intermittent injection used for symptomatic relief in patients receiving palliative care*. |
LU Authorization Period: 1 year | |
NOTE: *The patient must have a progressive life-limiting illness and require this medication for palliative purposes. | |
496 | For continuous infusion in patients receiving palliative sedation*. |
LU Authorization Period: 1 year | |
NOTE: *The patient must have a progressive life-limiting illness and require this medication for palliative purposes. |