Does J1932 require prior authorization?

Yes, J1932 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1932?

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

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`J1932`, Injection, lanreotide, (cipla), 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

For acromegaly: documentation of 'inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or dopamine agonist (e.g., bromocriptine, cabergoline) therapy' (record prior therapies and evidence of inadequate response or contraindication/unavailability of those therapies)
For Sandostatin LAR: documentation that 'initial treatment with Sandostatin subcutaneous injection has been shown to be effective and tolerated' prior to starting LAR (record of prior IR octreotide treatment response and tolerability)
For Signifor / Signifor LAR in Cushing's disease: documentation that pituitary surgery 'is not an option or has not been curative' (clinical notes indicating surgical candidacy or prior surgery with persistent disease)
Documentation of indication-specific clinical findings as appropriate (e.g., diagnosis of metastatic carcinoid tumor or VIPoma, evidence of severe diarrhea and flushing episodes, diagnosis of bleeding gastroesophageal varices, chemotherapy- or radiation-induced diarrhea, malignant bowel obstruction)
Administration documentation: Sandostatin LAR must be administered intramuscularly under physician supervision (record of administration date, dose, route, and supervising clinician)
Use of the policy's listed HCPCS/CPT/diagnosis codes when billing: HCPCS J1930, J1932, J2353, J2354, J2502 and the corresponding ICD-10 diagnosis codes listed in the policy's 'Applicable Codes' section (documentation should support linkage between diagnosis code and drug use)

Key Coverage Criteria

Acromegaly patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or dopamine agonist (e.g., bromocriptine, cabergoline) therapy
Severe diarrhea and flushing episodes associated with metastatic carcinoid tumors
Profuse watery diarrhea associated with vasoactive intestinal peptide tumors (VIPomas)-secreting tumors
Bleeding gastroesophageal varices associated with liver disease
Chemotherapy and/or radiation-induced diarrhea
Malignant bowel disease

20 Active Policies

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

BCBSLA-00820-A1DAB0AE0A, 00820 Lanreotide Products

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

MULTI

BCBSNJ-DRUGS-118-6096E061EB, Sandostatin, Sandostatin LAR depot (Octreotide), Somatuline Depo (lanreotide), Signifor LAR (pasireotide)

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

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

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

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

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

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

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

BCBSTN-106a2d4ddb, Lanreotide (Somatuline Depot; Lanreotide*)

BCBSTX-RX501.155, Lanreotide

EVICORE-MEDICAL_DRUG-E58B58AAC303, Lanreotide (Somatuline Depot, generic) Injection-non oncology

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

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

UHC-POL-somatostatin-analogs, Somatostatin Analogs

AETNA-CPB-0693, Somatostatin Analogs

BCBSIL-RX501.155, Lanreotide

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

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J1932, Injection, lanreotide, (cipla), 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

For acromegaly: documentation of 'inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or dopamine agonist (e.g., bromocriptine, cabergoline) therapy' (record prior therapies and evidence of inadequate response or contraindication/unavailability of those therapies)
For Sandostatin LAR: documentation that 'initial treatment with Sandostatin subcutaneous injection has been shown to be effective and tolerated' prior to starting LAR (record of prior IR octreotide treatment response and tolerability)
For Signifor / Signifor LAR in Cushing's disease: documentation that pituitary surgery 'is not an option or has not been curative' (clinical notes indicating surgical candidacy or prior surgery with persistent disease)
Documentation of indication-specific clinical findings as appropriate (e.g., diagnosis of metastatic carcinoid tumor or VIPoma, evidence of severe diarrhea and flushing episodes, diagnosis of bleeding gastroesophageal varices, chemotherapy- or radiation-induced diarrhea, malignant bowel obstruction)
Administration documentation: Sandostatin LAR must be administered intramuscularly under physician supervision (record of administration date, dose, route, and supervising clinician)
Use of the policy's listed HCPCS/CPT/diagnosis codes when billing: HCPCS J1930, J1932, J2353, J2354, J2502 and the corresponding ICD-10 diagnosis codes listed in the policy's 'Applicable Codes' section (documentation should support linkage between diagnosis code and drug use)

Key Coverage Criteria

Acromegaly patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or dopamine agonist (e.g., bromocriptine, cabergoline) therapy
Severe diarrhea and flushing episodes associated with metastatic carcinoid tumors
Profuse watery diarrhea associated with vasoactive intestinal peptide tumors (VIPomas)-secreting tumors
Bleeding gastroesophageal varices associated with liver disease
Chemotherapy and/or radiation-induced diarrhea
Malignant bowel disease

20 Active Policies

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

BCBSLA-00820-A1DAB0AE0A, 00820 Lanreotide Products

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

MULTI

BCBSNJ-DRUGS-118-6096E061EB, Sandostatin, Sandostatin LAR depot (Octreotide), Somatuline Depo (lanreotide), Signifor LAR (pasireotide)

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

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

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

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

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

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

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

BCBSTN-106a2d4ddb, Lanreotide (Somatuline Depot; Lanreotide*)

BCBSTX-RX501.155, Lanreotide

EVICORE-MEDICAL_DRUG-E58B58AAC303, Lanreotide (Somatuline Depot, generic) Injection-non oncology

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

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

UHC-POL-somatostatin-analogs, Somatostatin Analogs

AETNA-CPB-0693, Somatostatin Analogs

BCBSIL-RX501.155, Lanreotide

Have a follow-up question?

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

Ask Backwork about J1932 Sign up free

`J1932`, Injection, lanreotide, (cipla), 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1932`, Injection, lanreotide, (cipla), 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1932, Injection, lanreotide, (cipla), 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1932, Injection, lanreotide, (cipla), 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1932`, Injection, lanreotide, (cipla), 1 mg

`J1932`, Injection, lanreotide, (cipla), 1 mg