Does J0517 require prior authorization?

Yes, J0517 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J0517?

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

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`J0517`, Injection, benralizumab, 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 positive clinical response as demonstrated by at least one of the following: o Reduction in the frequency of exacerbations o Decreased utilization of rescue medications o Increase in percent predicted FEV1 from pretreatment baseline o Reduction in severity or frequency of asthma-related symptoms

Key Coverage Criteria

Covered when hospital outpatient facility infusion services for specialty medications and IVIG/SCIG therapy are considered medically necessary and the member meets the specific clinical criteria described in the policy.
Nucala for provider administration is proven for add-on therapy for patients who meet both of the following criteria: o Has an eosinophilic phenotype; and o Will be used as add-on maintenance therapy in the treatment of severe asthma
Medically necessary for Fasenra (benralizumab) for provider administration in EGPA when there is a diagnosis of EGPA with relapsing or refractory disease, defined by a history of EGPA and asthma plus at least two EGPA-typical features (histopathologic eosinophilic vasculitis, perivascular eosinophilic infiltration, eosinophil-rich granulomatous inflammation).
Target Agent(s) will be approved when ALL of the following are met: ONE of the following: A. The requested agent is eligible for continuation of therapy AND ONE of the following

20 Active Policies

FLORIDA_BLUE-FLBLUE-FASENRA-BENRALIZUMAB-7A823FD0BD, Fasenra benralizumab

BCBSLA-00606-CF193E9284, 00606 benralizumab (Fasenra)

BCBSM-2087166-6EA742BD44, FASENRA (BENRALIZUMAB)

POINT32HEALTH-PMNG-15511, Fasenra (benralizumab)

MULTI

POINT32HEALTH-PMNG-15521, Fasenra (benralizumab) Pen (autoinjector)

MULTI

POINT32HEALTH-PMNG-27781, Fasenra (benralizumab) Pen (autoinjector)

MULTI

BCBSNJ-DRUGS-133-2ADC519856, Monoclonal Interleukin-5 Antagonists [mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra)]

HEALTHNET_OR-HNOR-BENRALIZUMAB-FASENRA-CP-PHAR-373-1453044FCC, Benralizumab (Fasenra); CP.PHAR.373

MODA-FASENRA-B5C0B07947, Fasenra (benralizumab)

IBX-MEDICARE-ADVANTAGE-MA08-024O-D2920CA97B, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

UMR-POL-UMR-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

UMR-POL-UMR-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

SUREST-POL-SUREST-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-024O-19BF620A89, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

BCBSTN-fc4466fe66, Benralizumab (Fasenra)

EVICORE-MEDICAL_DRUG-89ED9491EEA0, Fasenra (benralizumab)Effective 10/01/2026

EVICORE-MEDICAL_DRUG-A505C3E8DB29, Fasenra (benralizumab)

UHC-COMM-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-3476B9F5B6, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Community Plan Medical Benefit Drug Policy

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

UHC-EXCH-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-0A5E0CE7F5, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Individual Exchange Medical Benefit Drug Policy

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J0517, Injection, benralizumab, 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 positive clinical response as demonstrated by at least one of the following: o Reduction in the frequency of exacerbations o Decreased utilization of rescue medications o Increase in percent predicted FEV1 from pretreatment baseline o Reduction in severity or frequency of asthma-related symptoms

Key Coverage Criteria

Covered when hospital outpatient facility infusion services for specialty medications and IVIG/SCIG therapy are considered medically necessary and the member meets the specific clinical criteria described in the policy.
Nucala for provider administration is proven for add-on therapy for patients who meet both of the following criteria: o Has an eosinophilic phenotype; and o Will be used as add-on maintenance therapy in the treatment of severe asthma
Medically necessary for Fasenra (benralizumab) for provider administration in EGPA when there is a diagnosis of EGPA with relapsing or refractory disease, defined by a history of EGPA and asthma plus at least two EGPA-typical features (histopathologic eosinophilic vasculitis, perivascular eosinophilic infiltration, eosinophil-rich granulomatous inflammation).
Target Agent(s) will be approved when ALL of the following are met: ONE of the following: A. The requested agent is eligible for continuation of therapy AND ONE of the following

20 Active Policies

FLORIDA_BLUE-FLBLUE-FASENRA-BENRALIZUMAB-7A823FD0BD, Fasenra benralizumab

BCBSLA-00606-CF193E9284, 00606 benralizumab (Fasenra)

BCBSM-2087166-6EA742BD44, FASENRA (BENRALIZUMAB)

POINT32HEALTH-PMNG-15511, Fasenra (benralizumab)

MULTI

POINT32HEALTH-PMNG-15521, Fasenra (benralizumab) Pen (autoinjector)

MULTI

POINT32HEALTH-PMNG-27781, Fasenra (benralizumab) Pen (autoinjector)

MULTI

BCBSNJ-DRUGS-133-2ADC519856, Monoclonal Interleukin-5 Antagonists [mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra)]

HEALTHNET_OR-HNOR-BENRALIZUMAB-FASENRA-CP-PHAR-373-1453044FCC, Benralizumab (Fasenra); CP.PHAR.373

MODA-FASENRA-B5C0B07947, Fasenra (benralizumab)

IBX-MEDICARE-ADVANTAGE-MA08-024O-D2920CA97B, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

UMR-POL-UMR-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

UMR-POL-UMR-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

SUREST-POL-SUREST-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-024O-19BF620A89, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

BCBSTN-fc4466fe66, Benralizumab (Fasenra)

EVICORE-MEDICAL_DRUG-89ED9491EEA0, Fasenra (benralizumab)Effective 10/01/2026

EVICORE-MEDICAL_DRUG-A505C3E8DB29, Fasenra (benralizumab)

UHC-COMM-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-3476B9F5B6, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Community Plan Medical Benefit Drug Policy

UHC-POL-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

UHC-EXCH-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-0A5E0CE7F5, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Individual Exchange Medical Benefit Drug Policy

Have a follow-up question?

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`J0517`, Injection, benralizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J0517`, Injection, benralizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J0517, Injection, benralizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J0517, Injection, benralizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J0517`, Injection, benralizumab, 1 mg

`J0517`, Injection, benralizumab, 1 mg