Does J1930 require prior authorization?

Yes, J1930 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1930?

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

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`J1930`, Injection, lanreotide, 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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.
Coverage determinations must include review of the member's benefit contract or SPD for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).
This Medical Benefit Drug Policy provides assistance in interpreting UnitedHealthcare standard benefit plans. When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan.
Documentation: Prior authorization required.

Key Coverage Criteria

Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
This policy addresses only the determination of medical necessity for the hospital outpatient setting for infusion and injectable therapy; the medical necessity of the pharmacologic or biologic medication itself may be reviewed separately.
Requests for select medications intended for administration in a hospital outpatient setting will be directed to a preferred alternative site of care (non-hospital affiliated outpatient facility or home).
Lanreotide is medically necessary for the long-term treatment of acromegaly in patients who have had an inadequate response to or cannot be treated with surgery and/or radiotherapy.
Oncology medications are medically necessary if (a) the drug is FDA-approved for the oncologic indication and used per FDA labeling, OR (b) the drug has an NCCN Category 1/2A/2B indication per NCCN Guidelines or NCCN Compendium.

20 Active Policies

ARKBLUE-LANREOTIDE-E-G-LANREOTIDE-INJECTION-SOMATULINE-D-8241A953A4, Lanreotide (e.g., Lanreotide injection, Somatuline depot)

HEALTHPARTNERS-CC-AENTRY-046147, Somatostatin analogues for acromegaly (Sandostatin LAR, Somatuline Depot, Signifor LAR, Somavert, Lanreotide)

MULTI

HEALTHNET_OR-HNOR-LANREOTIDE-SOMATULINE-DEPOT-AND-UNBRANDED-CP-PHAR-391-9E95B8B947, Lanreotide (Somatuline Depot and Unbranded); CP.PHAR.391

MODA-CUSTOM-LANREOTIDE-7AF218ADD2, Lanreotide: Somatuline Depot; Lanreotide

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-CZQMLI0MGK2M5CVMQ-NKBG-4A520B58A8, Somatuline Depot

IBX-COMMERCIAL-08-01-40H-5AD1ABE0D4, Lanreotide (Somatuline Depot)

IBX-MEDICARE-ADVANTAGE-MA08-090H-2A5DE3D2E6, Lanreotide (Somatuline Depot)

BCBSMT-RX501.155, Lanreotide

BCBSMT-RX502.061, Oncology Medications

BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care

BCBSNM-RX501.155, Lanreotide

BCBSNM-RX502.061, Oncology Medications

BCBSNM-ADM1001.034, Specialty Medication Administration Site of Care

BCBSOK-RX501.155, Lanreotide

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

BCBSOK-ADM1001.034, Specialty Medication Administration Site of Care

UMR-POL-UMR-somatostatin-analogs, Somatostatin Analogs

SUREST-POL-SUREST-somatostatin-analogs, Somatostatin Analogs

AMERIHEALTH-COMMERCIAL-08-01-40H-490B362EE8, Lanreotide (Somatuline Depot)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-090H-798433DB5E, Lanreotide (Somatuline Depot)

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J1930, Injection, lanreotide, 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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.
Coverage determinations must include review of the member's benefit contract or SPD for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).
This Medical Benefit Drug Policy provides assistance in interpreting UnitedHealthcare standard benefit plans. When deciding coverage, the member specific benefit plan document must be referenced as the terms of the member specific benefit plan may differ from the standard plan.
Documentation: Prior authorization required.

Key Coverage Criteria

Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
This policy addresses only the determination of medical necessity for the hospital outpatient setting for infusion and injectable therapy; the medical necessity of the pharmacologic or biologic medication itself may be reviewed separately.
Requests for select medications intended for administration in a hospital outpatient setting will be directed to a preferred alternative site of care (non-hospital affiliated outpatient facility or home).
Lanreotide is medically necessary for the long-term treatment of acromegaly in patients who have had an inadequate response to or cannot be treated with surgery and/or radiotherapy.
Oncology medications are medically necessary if (a) the drug is FDA-approved for the oncologic indication and used per FDA labeling, OR (b) the drug has an NCCN Category 1/2A/2B indication per NCCN Guidelines or NCCN Compendium.

20 Active Policies

ARKBLUE-LANREOTIDE-E-G-LANREOTIDE-INJECTION-SOMATULINE-D-8241A953A4, Lanreotide (e.g., Lanreotide injection, Somatuline depot)

HEALTHPARTNERS-CC-AENTRY-046147, Somatostatin analogues for acromegaly (Sandostatin LAR, Somatuline Depot, Signifor LAR, Somavert, Lanreotide)

MULTI

HEALTHNET_OR-HNOR-LANREOTIDE-SOMATULINE-DEPOT-AND-UNBRANDED-CP-PHAR-391-9E95B8B947, Lanreotide (Somatuline Depot and Unbranded); CP.PHAR.391

MODA-CUSTOM-LANREOTIDE-7AF218ADD2, Lanreotide: Somatuline Depot; Lanreotide

HIGHMARK_WHOLECARE-HMWC-MEDICAID-MEDICATIO-CZQMLI0MGK2M5CVMQ-NKBG-4A520B58A8, Somatuline Depot

IBX-COMMERCIAL-08-01-40H-5AD1ABE0D4, Lanreotide (Somatuline Depot)

IBX-MEDICARE-ADVANTAGE-MA08-090H-2A5DE3D2E6, Lanreotide (Somatuline Depot)

BCBSMT-RX501.155, Lanreotide

BCBSMT-RX502.061, Oncology Medications

BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care

BCBSNM-RX501.155, Lanreotide

BCBSNM-RX502.061, Oncology Medications

BCBSNM-ADM1001.034, Specialty Medication Administration Site of Care

BCBSOK-RX501.155, Lanreotide

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

BCBSOK-ADM1001.034, Specialty Medication Administration Site of Care

UMR-POL-UMR-somatostatin-analogs, Somatostatin Analogs

SUREST-POL-SUREST-somatostatin-analogs, Somatostatin Analogs

AMERIHEALTH-COMMERCIAL-08-01-40H-490B362EE8, Lanreotide (Somatuline Depot)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-090H-798433DB5E, Lanreotide (Somatuline Depot)

Have a follow-up question?

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

Ask Backwork about J1930 Sign up free

`J1930`, Injection, lanreotide, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1930`, Injection, lanreotide, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1930, Injection, lanreotide, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1930, Injection, lanreotide, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1930`, Injection, lanreotide, 1 mg

`J1930`, Injection, lanreotide, 1 mg