Does J0584 require prior authorization?

Yes, J0584 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J0584?

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

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`J0584`, Injection, burosumab-twza 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: Radiographic evidence of rickets or XLH-associated bone disease.
Documentation: Genetic confirmation of a PHEX mutation in the member.
Documentation: PHEX mutation in a directly related family member with X-linked inheritance.
Documentation: Serum FGF23 level above ULN.
Documentation: Continuation - chart notes showing response to therapy.
Documentation: TIO initial—FGF23 above ULN.

Key Coverage Criteria

Indication: XLH in adults and children aged 6 months and older.
Indication: FGF23-related hypophosphatemia in TIO with non-resectable/non-localizable phosphaturic mesenchymal tumors in patients 2 years and older.
X-linked Hypophosphatemia (XLH) indication: Disease response to burosumab is defined by biochemical and clinical improvements including increased serum phosphorus, improved renal phosphate handling, lower alkaline phosphatase, and/or improvement in skeletal symptoms or radiographic findings of rickets/osteomalacia; AND

20 Active Policies

ARKBLUE-BUROSUMAB-TWZA-E-G-CRYSVITA-E54FB657AB, Burosumab-twza (e.g., Crysvita)

BCBSLA-00633-3C46E477B8, 00633 burosumab-twza (Crysvita)

BCBSM-2092938-CACF98E156, CRYSVITA (BUROSUMAB-TWZA)

BCBSMS-S-5-01-541-2E68C50398, State and School Employees' Health Insurance Plan - Crysvita (burosumab-twza)

BCBSMS-L-5-01-541-4A06D213F8, Crysvita (burosumab-twza)

POINT32HEALTH-MDMNG-12701, Crysvita (burosumab-twza)

MULTI

HEALTHPARTNERS-CC-ENTRY-202452, Burosumab (Crysvita)

MULTI

HEALTHPARTNERS-CC-ENTRY-204623, Burosumab (Crysvita) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-12711, Crysvita (burosumab-twza)

MULTI

BCBSND-BUROSUMAB-CRYSVITA-B88AA0DD0D, Burosumab Crysvita

BCBSNE-X-117-45AA259DAF, CRYSVITA

BCBSNJ-DRUGS-180-61BD1379FC, Burosumab-twza (Crysvita)

MODA-CRYSVITA-80D25B136E, Crysvita (burosumab-twza)

HEALTHNET_OR-HNOR-BUROSUMAB-TWZA-CRYSVITA-CP-PHAR-11-D21582BFE5, Burosumab-twza (Crysvita); CP.PHAR.11

IBX-MEDICARE-ADVANTAGE-MA08-099B-C8844F5FF3, Burosumab-twza (Crysvita)

IBX-COMMERCIAL-08-01-49B-B958651680, Burosumab-twza (Crysvita)

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-QEPVJEW3DK-EJUWHXOLROQ-49345E9009, Crysvita

BCBSTN-89ccb2d250, Burosumab-twza(Crysvita)

EVICORE-MEDICAL_DRUG-94E6B75AA108, Crysvita (burosumab-twza) Non-oncology

UHC-COMM-MD-CRYSVITA-BUROSUMAB-TWZA-COMMUNITY-PLAN-M-9BA463C96F, Crysvita (Burosumab-Twza) – Community Plan Medical Benefit Drug Policy

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

Ask Backwork about J0584 Sign up free

J0584, Injection, burosumab-twza 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: Radiographic evidence of rickets or XLH-associated bone disease.
Documentation: Genetic confirmation of a PHEX mutation in the member.
Documentation: PHEX mutation in a directly related family member with X-linked inheritance.
Documentation: Serum FGF23 level above ULN.
Documentation: Continuation - chart notes showing response to therapy.
Documentation: TIO initial—FGF23 above ULN.

Key Coverage Criteria

Indication: XLH in adults and children aged 6 months and older.
Indication: FGF23-related hypophosphatemia in TIO with non-resectable/non-localizable phosphaturic mesenchymal tumors in patients 2 years and older.
X-linked Hypophosphatemia (XLH) indication: Disease response to burosumab is defined by biochemical and clinical improvements including increased serum phosphorus, improved renal phosphate handling, lower alkaline phosphatase, and/or improvement in skeletal symptoms or radiographic findings of rickets/osteomalacia; AND

20 Active Policies

ARKBLUE-BUROSUMAB-TWZA-E-G-CRYSVITA-E54FB657AB, Burosumab-twza (e.g., Crysvita)

BCBSLA-00633-3C46E477B8, 00633 burosumab-twza (Crysvita)

BCBSM-2092938-CACF98E156, CRYSVITA (BUROSUMAB-TWZA)

BCBSMS-S-5-01-541-2E68C50398, State and School Employees' Health Insurance Plan - Crysvita (burosumab-twza)

BCBSMS-L-5-01-541-4A06D213F8, Crysvita (burosumab-twza)

POINT32HEALTH-MDMNG-12701, Crysvita (burosumab-twza)

MULTI

HEALTHPARTNERS-CC-ENTRY-202452, Burosumab (Crysvita)

MULTI

HEALTHPARTNERS-CC-ENTRY-204623, Burosumab (Crysvita) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-12711, Crysvita (burosumab-twza)

MULTI

BCBSND-BUROSUMAB-CRYSVITA-B88AA0DD0D, Burosumab Crysvita

BCBSNE-X-117-45AA259DAF, CRYSVITA

BCBSNJ-DRUGS-180-61BD1379FC, Burosumab-twza (Crysvita)

MODA-CRYSVITA-80D25B136E, Crysvita (burosumab-twza)

HEALTHNET_OR-HNOR-BUROSUMAB-TWZA-CRYSVITA-CP-PHAR-11-D21582BFE5, Burosumab-twza (Crysvita); CP.PHAR.11

IBX-MEDICARE-ADVANTAGE-MA08-099B-C8844F5FF3, Burosumab-twza (Crysvita)

IBX-COMMERCIAL-08-01-49B-B958651680, Burosumab-twza (Crysvita)

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-QEPVJEW3DK-EJUWHXOLROQ-49345E9009, Crysvita

BCBSTN-89ccb2d250, Burosumab-twza(Crysvita)

EVICORE-MEDICAL_DRUG-94E6B75AA108, Crysvita (burosumab-twza) Non-oncology

UHC-COMM-MD-CRYSVITA-BUROSUMAB-TWZA-COMMUNITY-PLAN-M-9BA463C96F, Crysvita (Burosumab-Twza) – Community Plan Medical Benefit Drug Policy

Have a follow-up question?

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

Ask Backwork about J0584 Sign up free

J0584, Injection, burosumab-twza 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Have a follow-up question?

J0584, Injection, burosumab-twza 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Have a follow-up question?

`J0584`, Injection, burosumab-twza 1 mg

`J0584`, Injection, burosumab-twza 1 mg