Does J0222 require prior authorization?

Yes, J0222 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J0222?

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

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`J0222`, Injection, patisiran, 0.1 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation of transthyretin pathogenic variant as confirmed by genetic testing.
Documentation of symptomatic polyneuropathy (examples provided: reduced motor strength/coordination, impaired sensation [e.g., pain, temperature, vibration, touch]).
Documentation of patient age (must be 18 years of age or older).
Documentation that Onpattro is prescribed by or in consultation with a neurologist, geneticist, or a physician who specializes in the treatment of amyloidosis.
Documentation of actual body weight to determine dosing (weight <100 kg: 0.3 mg/kg q3 weeks; weight ≥100 kg: 30 mg q3 weeks).
Patisiran is administered IV: 0.3 mg/kg every 3 weeks if <100 kg, or 30 mg every 3 weeks if ≥100 kg; require premedication with IV corticosteroid, acetaminophen, IV H1 blocker, IV H2 blocker prior to administration.

Key Coverage Criteria

Onpattro is indicated for the treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis in adults.
Polyneuropathy of Hereditary Transthyretin-Mediated Amyloidosis (must meet all coverage criteria listed below).
Patisiran and vutrisiran are medically necessary for adults (age >=18) with genetically confirmed or biopsy-proven hATTR polyneuropathy meeting: 18+, confirmatory diagnosis by genetic test or biopsy showing amyloid; polyneuropathy with PND IIIb or FAP stage 1-2; and no NYHA class III/IV HF or non-hATTR neuropathies.
Patisiran and vutrisiran are medically necessary for adults (>=18) with genetically or biopsy-confirmed hATTR polyneuropathy, who have baseline PND IIIb or better or FAP stage 1-2, and do not have NYHA class III/IV heart failure or non-hATTR neuropathies.
Patisiran and vutrisiran are medically necessary for adults (18+ years) with confirmed hATTR by genetic test or tissue biopsy, with polyneuropathy as defined (PND ≤IIIb or FAP Stage 1-2), and without advanced heart failure or unrelated neuropathies.
Authorization for 12 months of Onpattro may be granted for treatment of polyneuropathy of hereditary transthyretin-mediated amyloidosis (ATTR-FAP) when all of the following criteria are met: age ≥18; pathogenic TTR variant detected; clinical manifestations of ATTR-FAP present; and not used in combination with vutrisiran, inotersen, eplontersen, tafamids meglumine, tafamidz (typo in source as shown), or acoramidis.

20 Active Policies

ARKBLUE-TREATMENT-OF-HEREDITARY-TRANSTHYRETIN-MEDIATED-A-5A1A448822, Treatment of Hereditary Transthyretin-mediated Amyloidosis [Patisiran (e.g., Onpattro) and Vutrisiran (e.g., Amvuttra)]

FLORIDA_BLUE-FLBLUE-PHARMACOLOGIC-TREATMENT-OF-HEREDITARY-TRANSTHYRETIN-MEDIATED-E107333D17, Pharmacologic Treatment of Hereditary Transthyretin-Mediated Amyloidosis (Onpattro/Tegsedi/Amvuttra)

BCBSM-2100716-6D3B8CBFD6, ONPATTRO (PATISIRAN)

HEALTHPARTNERS-CC-ENTRY-207226, hATTR medications - patisiran (Onpattro) and vutrisiran (Amvuttra)

MULTI

BCBSNJ-DRUGS-182-8171B432A4, Patisiran (Onpattro)

MODA-ONPATTRO-B8D181EC33, Onpattro (patisiran lipid complex)

IBX-MEDICARE-ADVANTAGE-MA08-100E-CDA714F7FC, patisiran (Onpattro) and vutrisiran (Amvuttra)

IBX-COMMERCIAL-08-01-50E-DE042035C9, Patisiran (Onpattro) and vutrisiran (Amvuttra)

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-85RYGY0QKKY-VJBM1MRHW-929A63874C, Onpattro,Tegsedi and Amvuttra

AMERIHEALTH-COMMERCIAL-08-01-50E-D1F9C11E01, Patisiran (Onpattro) and vutrisiran (Amvuttra)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-100E-7F5C63CFBD, patisiran (Onpattro) and vutrisiran (Amvuttra)

BCBSIL-RX501.146, Vutrisiran (Amvuttra) and Patisiran (Onpattro)

BCBSMT-RX501.146, Vutrisiran (Amvuttra) and Patisiran (Onpattro)

BCBSNM-RX501.146, Vutrisiran (Amvuttra) and Patisiran (Onpattro)

BCBSOK-RX501.146, Vutrisiran (Amvuttra) and Patisiran (Onpattro)

BCBSTN-5e845389aa, Patisiran Lipid Complex (Onpattro)

BCBSTX-RX501.146, Vutrisiran (Amvuttra) and Patisiran (Onpattro)

EVICORE-MEDICAL_DRUG-01C6B1F337EF, Onpattro (patisiran)

EVICORE-MEDICAL_DRUG-68199469FC9C, Onpattro (patisiran)Effective 09/01/2026

UHC-COMM-MD-RNA-TARGETED-THERAPIES-AMVUTTRA-AND-ONPA-3B4B45AD98, RNA-Targeted Therapies (Amvuttra and Onpattro) – Community Plan Medical Benefit Drug Policy

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J0222, Injection, patisiran, 0.1 mg