Does J0480 require prior authorization?

No, J0480 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J0480?

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

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`J0480`, Injection, basiliximab, 20 mg

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Medical records documenting absence of contraindicated prior toxicities for retreatment (e.g., no prior sustained VT ≥5 beats, uncontrolled arrhythmias, prolonged intubation/dialysis, prolonged coma/toxic psychosis, bowel ischemia/perforation, GI bleeding requiring surgery, etc.).
Monitoring and adverse event documentation (evidence of monitoring for capillary leak syndrome, infections, neurologic status, hemodynamics) as part of treatment records.

Records of prior drug‑related toxicities from earlier IL‑2 courses (to assess contraindications to retreatment), including any occurrences of sustained ventricular tachycardia, uncontrolled arrhythmias, chest pain with ECG changes, cardiac tamponade, prolonged intubation, dialysis‑requiring renal failure, coma/toxic psychosis, refractory seizures, bowel ischemia/perforation, or GI bleeding requiring surgery.

Documentation of diagnosis corresponding to a covered indication (e.g., metastatic renal cell carcinoma with clear cell histology, metastatic or unresectable cutaneous melanoma, chronic GVHD refractory to first‑line therapy, neuroblastoma).

Key Coverage Criteria

Cutaneous melanoma — as high-dose single-agent subsequent therapy for metastatic or unresectable disease
Metastatic melanoma (FDA‑approved indication for treatment of adults with metastatic melanoma)
Metastatic renal cell carcinoma with clear cell histology (FDA‑approved indication for treatment of adults with metastatic renal cell carcinoma)
Chronic graft‑versus‑host disease (GVHD) — for treatment as additional therapy in conjunction with systemic corticosteroids following no response to first‑line therapy options
Neuroblastoma — for treatment of neuroblastoma (see CPB 0895 - Dinutuximab (Unituxin))
Intralesional/intratumoral administration of IL‑2 for melanoma (intralesional IL‑2 CPT codes 96405/96406 covered when selection criteria met)

2 Active Policies

AETNA-CPB-0024, Aldesleukin (Proleukin)

AETNA-CPB-0596, Liver Transplantation

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J0480, Injection, basiliximab, 20 mg