Does J1301 require prior authorization?

Yes, J1301 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1301?

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

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`J1301`, Injection, edaravone, 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

Submission of medical records (e.g., chart notes, previous medical history, diagnostic testing including imaging, nerve conduction studies, laboratory values) to support the diagnosis of ALS.
Submission of the most recent ALS Functional Rating Scale-Revised (ALSFRS-R) score confirming that the patient has scores 63; 2 in all items of the ALSFRS-R criteria at the start of treatment.
Submission of medical records (e.g., chart notes, laboratory values) confirming that the patient has a % forced vital capacity (%FVC) 63; 80% at the start of treatment.
Provider attestation that the patient or caregiver is not competent or is physically unable to administer Radicava ORS oral suspension either orally or via feeding tube.
Documentation that edaravone is prescribed by, or in consultation with, a neurologist with expertise in the diagnosis of ALS.
For continuation: documentation that the patient is currently receiving edaravone therapy and is not dependent on invasive ventilation, and that dosing is per FDA labeling.

Key Coverage Criteria

Submission of medical records (e.g., chart notes, laboratory values) confirming that the patient has a % forced vital capacity (%FVC) 63; 80 % at the start of treatment; and
Edaravone dosing for ALS is in accordance with the United States Food and Drug Administration approved labeling; and
Edaravone is proven and medically necessary for the treatment of amyotrophic lateral sclerosis (ALS) in patients who meet all of the following criteria:
For initial therapy, all of the following:
Submission of medical records (e.g., chart notes, previous medical history, diagnostic testing including imaging, nerve conduction studies, laboratory values) to support the diagnosis of ALS; and
Submission of the most recent ALS Functional Rating Scale-Revised (ALSFRS-R) score confirming that the patient has scores 63; 2 in all items of the ALSFRS-R criteria at the start of treatment; and

20 Active Policies

ARKBLUE-EDARAVONE-E-G-RADICAVA-EDDDD8C07D, Edaravone (e.g., Radicava)

FLORIDA_BLUE-FLBLUE-RADICAVA-EDARAVONE-INJECTION-2B622717CA, Radicava (edaravone injection)

BCBSLA-00596-11F4893DF4, 00596 edaravone (Radicava, Radicava ORS, generics)

BCBSM-2077749-BD9EE7D1B7, RADICAVA (EDARAVON)

BCBSMS-S-5-01-514-E538EE082C, State and School Employees' Health Insurance Plan - Radicava (edaravone)

BCBSMS-L-5-01-514-E9F1425A37, Radicava (edaravone)

HEALTHPARTNERS-CC-ENTRY-197092, Edaravone (Radicava)

MULTI

HEALTHPARTNERS-CC-ENTRY-202923, Edaravone (Radicava) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-13546, Radicava (edaravone)

MULTI

POINT32HEALTH-MDMNG-13556, Radicava (edaravone)

MULTI

POINT32HEALTH-PMNG-17671, Radicava ORS (edaravone)

MULTI

POINT32HEALTH-PMNG-17851, Radicava ORS (edaravone)

MULTI

BCBSND-EDARAVONE-RADICAVA-B415B64BF5, Edaravone Radicava

BCBSNE-X-88-C91656830F, RADICAVA/EDARAVONE (PREAUTHORIZATION REQUIRED)

BCBSNJ-DRUGS-156-CCDD6F6F95, Edaravone (Radicava)

HEALTHNET_OR-HNOR-EDARAVONE-RADICAVA-RADIVACA-ORS-CP-PHAR-343-94CC7EE4AE, Edaravone (Radicava, Radivaca ORS); CP.PHAR.343

MODA-RADICAVA-792873A7FB, Radicava (edaravone)

UHC-POL-edaravone, Edaravone

UHC-EXCH-MD-EDARAVONE-INDIVIDUAL-EXCHANGE-MEDICAL-BE-211F685188, Edaravone – Individual Exchange Medical Benefit Drug Policy

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

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J1301, Injection, edaravone, 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

Submission of medical records (e.g., chart notes, previous medical history, diagnostic testing including imaging, nerve conduction studies, laboratory values) to support the diagnosis of ALS.
Submission of the most recent ALS Functional Rating Scale-Revised (ALSFRS-R) score confirming that the patient has scores 63; 2 in all items of the ALSFRS-R criteria at the start of treatment.
Submission of medical records (e.g., chart notes, laboratory values) confirming that the patient has a % forced vital capacity (%FVC) 63; 80% at the start of treatment.
Provider attestation that the patient or caregiver is not competent or is physically unable to administer Radicava ORS oral suspension either orally or via feeding tube.
Documentation that edaravone is prescribed by, or in consultation with, a neurologist with expertise in the diagnosis of ALS.
For continuation: documentation that the patient is currently receiving edaravone therapy and is not dependent on invasive ventilation, and that dosing is per FDA labeling.

Key Coverage Criteria

Submission of medical records (e.g., chart notes, laboratory values) confirming that the patient has a % forced vital capacity (%FVC) 63; 80 % at the start of treatment; and
Edaravone dosing for ALS is in accordance with the United States Food and Drug Administration approved labeling; and
Edaravone is proven and medically necessary for the treatment of amyotrophic lateral sclerosis (ALS) in patients who meet all of the following criteria:
For initial therapy, all of the following:
Submission of medical records (e.g., chart notes, previous medical history, diagnostic testing including imaging, nerve conduction studies, laboratory values) to support the diagnosis of ALS; and
Submission of the most recent ALS Functional Rating Scale-Revised (ALSFRS-R) score confirming that the patient has scores 63; 2 in all items of the ALSFRS-R criteria at the start of treatment; and

20 Active Policies

ARKBLUE-EDARAVONE-E-G-RADICAVA-EDDDD8C07D, Edaravone (e.g., Radicava)

FLORIDA_BLUE-FLBLUE-RADICAVA-EDARAVONE-INJECTION-2B622717CA, Radicava (edaravone injection)

BCBSLA-00596-11F4893DF4, 00596 edaravone (Radicava, Radicava ORS, generics)

BCBSM-2077749-BD9EE7D1B7, RADICAVA (EDARAVON)

BCBSMS-S-5-01-514-E538EE082C, State and School Employees' Health Insurance Plan - Radicava (edaravone)

BCBSMS-L-5-01-514-E9F1425A37, Radicava (edaravone)

HEALTHPARTNERS-CC-ENTRY-197092, Edaravone (Radicava)

MULTI

HEALTHPARTNERS-CC-ENTRY-202923, Edaravone (Radicava) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-13546, Radicava (edaravone)

MULTI

POINT32HEALTH-MDMNG-13556, Radicava (edaravone)

MULTI

POINT32HEALTH-PMNG-17671, Radicava ORS (edaravone)

MULTI

POINT32HEALTH-PMNG-17851, Radicava ORS (edaravone)

MULTI

BCBSND-EDARAVONE-RADICAVA-B415B64BF5, Edaravone Radicava

BCBSNE-X-88-C91656830F, RADICAVA/EDARAVONE (PREAUTHORIZATION REQUIRED)

BCBSNJ-DRUGS-156-CCDD6F6F95, Edaravone (Radicava)

HEALTHNET_OR-HNOR-EDARAVONE-RADICAVA-RADIVACA-ORS-CP-PHAR-343-94CC7EE4AE, Edaravone (Radicava, Radivaca ORS); CP.PHAR.343

MODA-RADICAVA-792873A7FB, Radicava (edaravone)

UHC-POL-edaravone, Edaravone

UHC-EXCH-MD-EDARAVONE-INDIVIDUAL-EXCHANGE-MEDICAL-BE-211F685188, Edaravone – Individual Exchange Medical Benefit Drug Policy

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

Have a follow-up question?

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

Ask Backwork about J1301 Sign up free

`J1301`, Injection, edaravone, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1301`, Injection, edaravone, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1301, Injection, edaravone, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1301, Injection, edaravone, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1301`, Injection, edaravone, 1 mg

`J1301`, Injection, edaravone, 1 mg