J9296, Injection, pemetrexed (accord), not therapeutically equivalent to j9305, 10 mg
HCPCS/CPT
Prior Authorization
Prior Auth Required
Code explicitly requires prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Key Coverage Criteria
- Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
- Coverage is provided for injectable oncology medications listed in the NCCN Compendium with Categories of Evidence and Consensus of 1, 2A, or 2B as proven and medically necessary; categories with 3 are unproven and not medically necessary.
- Coverage is provided for injectable oncology medications listed in the NCCN Compendium with Categories of Evidence and Consensus of 1, 2A, or 2B as proven and medically necessary; Category 3 is unproven and not medically necessary. If NCCN has no compendium, coverage determinations are based on FDA labeling.
11 Active Policies
UHC-POL-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage
UMR-POL-UMR-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage
SUREST-POL-SUREST-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage
EVICORE-HPLAN-CIGNA-91DEEEDD92F8, Cigna MedOnc Master Drug List
Related Codes
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