Provider Notice: Interfyl (HCPC Q4171) - Not a Covered Benefit

Date: 01/07/22

Consistent with the Clinical Policy, CP.MP.36, Experimental Technologies, the biological product, Interfyl (HCPC Q4171) is a non-covered experimental/investigational product for CHIP, Health Insurance Marketplace (Ambetter from Superior HealthPlan) and Medicare Advantage (Wellcare By Allwell [HMO and HMO SNP]) members, as the Food and Drug Administration has not approved Interfyl for any use at this time.

To review all clinical and payment policies, please visit  the Superior Clinical, Payment and Pharmacy Policies webpage and the Ambetter Clinical, Payment and Pharmacy Policies webpage.

For questions or additional information, please contact Superior Provider Services at:

• 1-877-391-5921 CHIP, Wellcare By Allwell (HMO and HMO SNP)
• 1-877-687-1196 (Ambetter from Superior HealthPlan)