Does J2428 require prior authorization?

Yes, J2428 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J2428?

Medicare facility rate: N/A. Non-facility rate: N/A. Work RVU: 0.00.

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`J2428`, Injection, paliperidone palmitate extended release (erzofri), 1 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

4 Active Policies

ARKBLUE-PALIPERIDONE-PALMITATE-E-G-LONG-ACTING-INJECTABL-319D8B4C9E, Paliperidone Palmitate (e.g., Long-acting Injectables Invega Sustenna & Invega Trinza, Erzofri)

BCBSMS-L-5-01-621-76E7CE76DD, Erzofri (paliperidone palmitate)

BCBSMS-S-5-01-621-FED8A52A73, State and School Employees' Health Insurance Plan - Erzofri (paliperidone palmitate)

Related Codes

J2426(2 policies)J2427(2 policies)

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