Does J3420 require prior authorization?

No, J3420 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for J3420?

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

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information (e.g., complete name and dates of service).
The documentation must include the legible signature of the physician or non-physician practitioner responsible for and providing the care.
The submitted medical record must support the use of the selected ICD-10-CM code(s) for the service billed.

Vitamin B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.
Vitamin B12 injection is covered when the beneficiary has a documented history of a low serum vitamin B12 level.
Vitamin B12 injection is covered when used to treat conditions that cause or are caused by low serum vitamin B12 (e.g., pernicious anemia, malabsorption syndromes).
For patients receiving pemetrexed, give one intramuscular vitamin B12 injection during the week preceding the first pemetrexed dose and repeat every three pemetrexed cycles thereafter.
For patients receiving pralatrexate, give 1 mg intramuscular vitamin B12 no more than 10 weeks prior to the first pralatrexate dose and repeat every 8-10 weeks thereafter.
Subsequent vitamin B12 injections for pemetrexed or pralatrexate patients may be administered on the same day as the chemotherapy infusion.

AETNA-CPB-0016 — Back Pain - Invasive Procedures

AETNA-CPB-0388 — Complementary and Alternative Medicine

AETNA-CPB-0406 — Tinnitus Treatments

AETNA-CPB-0648 — Autism Spectrum Disorders

AETNA-CPB-0725 — Post-Herpetic Neuralgia

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