Does J1950 require prior authorization?

Yes, J1950 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1950?

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

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`J1950`, Injection, leuprolide acetate (for depot suspension), per 3.75 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

Medical records for patients receiving a once‑yearly implant must document ongoing follow‑up visits at least every 3 to 4 months and must be provided upon request; lack of requested documentation will result in denial as not medically necessary.
Physician documentation supporting reasonable expectation of survival >12 months is required for coverage of once‑yearly implants for prostate cancer.
Billing frequency should match the drug formulation administered (e.g., bill Vantas 50 mg implant once per 12 months, Eligard 22.5 mg billed per its 3‑month formulation); medical record must support billed frequency when requested.
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).

Key Coverage Criteria

GnRH/LHRH analogs (leuprolide, goserelin, triptorelin, histrelin, leuprolide mesylate/Camcevi) are covered for FDA‑approved indications and for recognized off‑label uses that meet the criteria of LCD L33394.
Leuprolide acetate and histrelin implants administered every 12 months are covered for treatment of prostate cancer when the treating physician reasonably expects the patient to survive at least 12 months.
GnRH analogs are covered when administered at frequencies consistent with the specific product's labeled duration of action (e.g., monthly, every 3, 4, 6, or 12 months).
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.
GnRH agonists and antagonists may be medically necessary for listed indications (endometriosis, CPP, fibroids, preoperative anemia management in fibroids) as documented in the policy table; use is limited to FDA-labeled indications or as specified in the table of indications.

20 Active Policies

ARKBLUE-LEUPROLIDE-ACETATE-E-G-LUPRON-DEPOT-FENSOLVI-FOR-F7F51D8453, Leuprolide Acetate (e.g., Lupron Depot; Fensolvi) for Non-Oncologic Indications

A52453, Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JJ-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JM-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

HEALTHNET_OR-HNOR-LEUPROLIDE-ACETATE-ELIGARD-FENSOLVI-LUPRON-DEPOT-LUPRON-AC35C644FA, Leuprolide Acetate (Eligard, Fensolvi, Lupron Depot, Lupron Depot-Ped), Leuprolide mesylate (Camcevi); CP.PCH.53.

IBX-COMMERCIAL-08-01-33M-EFAC8FE1D4, Leuprolide (Camcevi, Camcevi ETM, Eligard, Fensolvi, Lupron Depot)

IBX-MEDICARE-ADVANTAGE-MA08-083M-246AFCEE23, Leuprolide (Camcevi, Camcevi ETM, Eligard, Fensolvi, Lupron Depot)

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSMT-RX502.061, Oncology Medications

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

BCBSNM-RX502.061, Oncology Medications

BCBSOK-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSOK-RX502.061, Oncology Medications

UMR-POL-UMR-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

UMR-POL-UMR-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

SUREST-POL-SUREST-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

SUREST-POL-SUREST-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

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J1950, Injection, leuprolide acetate (for depot suspension), per 3.75 mg