Does 96377 require prior authorization?

No, 96377 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for 96377?

Medicare facility rate: $19.04. Non-facility rate: $19.04. Work RVU: 0.17.

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.17

Facility

$19.04

Non-Facility

$19.04

When Neulasta® or UDENYCA® is administered by prefilled syringe, report the drug HCPCS code (J2506 or Q5111) and the administration CPT code 96372 in the medical record/claim.
When Neulasta® or UDENYCA® is administered via an on-body injector (Neulasta® Onpro® or UDENYCA® ONBODY™), document and identify use of the on-body injector in the medical record and report CPT code 96377 (application of on-body injector).
Document that the provider filled the injector device and applied it to the patient (provider does not inject the drug manually) when billing for on-body injector use.
Clear documentation in the medical record is required to justify same‑day administration and must be available upon request.

Pegfilgrastim (Neulasta® or UDENYCA®) is covered to decrease the incidence of infection manifested by febrile neutropenia in patients with non-myeloid malignancies receiving myelosuppressive anti-cancer drugs associated with a clinically significant incidence of febrile neutropenia.
Pegfilgrastim (J2506) is indicated to decrease the incidence of infection manifested by febrile neutropenia in patients with nonmyeloid malignancies receiving myelosuppressive chemotherapy associated with a clinically significant incidence of febrile neutropenia.
Pegfilgrastim may be administered via prefilled syringe or via an on-body injector (e.g., Neulasta Onpro or UDENYCA ONBODY) as approved delivery methods.
Same‑day administration (on the day of chemotherapy) may be allowed when patient or caregiver circumstances create a significant barrier to returning for next‑day dosing (for example, lack of transportation).
- Adult AML shortly after completion of induction or repeat induction chemotherapy, or after consolidation chemotherapy for AML.
- Treatment of severe neutropenia in hairy cell leukemia.

A54682 — Billing and Coding: Neulasta (pegfilgrastim) Onpro Kit / UDENYCA ONBODY (On-body Injector)

A59126 — Pegfilgrastim (Fulphila; Neulasta; Neulasta Onpro; Nyvepria; Udenyca; Ziextenzo) J2506

L37176 — White Cell Colony Stimulating Factors

CARELON-febrile-neutropenia-risk — Febrile Neutropenia Risk

Ask Verity about documentation requirements, denial risks, or coverage in your state.