Does J1110 require prior authorization?

No, J1110 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J1110?

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

Backwork Sign up free

`J1110`, Injection, dihydroergotamine mesylate, per 1 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

Documentation that other intractable severe migraine attacks were unresponsive to analgesics and triptans (example list of triptans provided in policy).
For Eptinezumab-jjmr (Vyepti): documentation that the member is an adult with migraine and meets criteria per CPB 0970 (referenced by policy).

For IM ketorolac: documentation that use is short-term (<= 5 days) and for acute migraine diagnosis codes listed in policy (examples: G43.001 - G43.619, G43.B0 - G43.B1, G43.801 - G43.919).

No documentation requirements are specified in this Appendix section.

For PDPH treatments (caffeine/cosyntropin): documentation of PDPH diagnosis (timing and features) and any prior conservative measures employed.

For treatment of medication overuse headache with IV DHE, documentation supporting inpatient management and diagnosis of medication overuse headache.

Key Coverage Criteria

Magnesium supplementation for migraine prevention in adults (limited evidence from small RCTs with mixed results; discussed as a possible option).
IV ketamine infusion combined with magnesium sulfate for chronic intractable cluster headache (case reports showing symptomatic relief; Moisset et al. 2017).
Intravenous and intranasal ketamine for acute/abortive treatment of migraine (multiple small RCTs, open-label studies and systematic reviews/meta-analyses; potential short-term analgesic benefit reported).
Inpatient continuous or multi-day ketamine or lidocaine infusion protocols as therapy for refractory chronic migraine (rCM) when other treatments have failed (practice series and pilot studies; Mojica et al. 2021; Schwenk et al. 2021; Ray et al. 2022).
Transcutaneous supraorbital neurostimulation (tSNS, Cefaly device / extra-cephalic supraorbital TNS) for preventive treatment of episodic migraine (randomized trial evidence suggesting superiority to sham in episodic migraine prevention; Russo & Tessitore 2015; UpToDate summary referencing RCT).
Intramuscular (IM) ketorolac (Toradol) for acute migraine treatment in adults (RCTs comparing IM ketorolac to other agents showing similar efficacy; Duarte et al. 1992; Shrestha et al. 1996; also supported in ED settings per UpToDate).

1 Active Policy

AETNA-CPB-0462, Headaches: Nonsurgical Management

Have a follow-up question?

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

Ask Backwork about J1110 Sign up free

J1110, Injection, dihydroergotamine mesylate, per 1 mg