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[removed]Mississippi Division of Medicaid Synagis® Prior Authorization Criteria* Beneficiaries must meet at least one of the bullet point criteria for age at beginning of the RSV season. Age ≤ 1 year at start of RSV se
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Document Date: 2014-12-16 19:38:03


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MedicalCondition

ineffective cough / congestive heart failure / severe pulmonary exacerbation / hypertension / cystic fibrosis AND / chronic lung disease / CHD / chronic ventilator therapy / chronic continued medical support / congenital abnormalities / severe lung disease AND / OR neuromuscular disease / cyanotic heart disease / Respiratory Syncytial Virus Infection / Down Syndrome / acyanotic heart disease / /

MedicalTreatment

chemotherapy / cardiac surgery / organ transplants / /

Organization

American Academy / Infectious Diseases and Bronchiolitis Guidelines Committee / Pediatric Committee on Infectious Diseases / Mississippi Division of Medicaid Synagis / /

Position

cardiologist / /

Product

Synagis / /

Technology

transplantation / tomography / chemotherapy / /

URL

http /

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