Does J1954 require prior authorization?

Yes, J1954 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J1954?

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

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`J1954`, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 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.
Documentation of the covered diagnosis that matches one of the approved indications (e.g., CPP, gender dysphoria, fibroids, abnormal uterine bleeding, premenstrual disorders, endometriosis)
For Fensolvi: documentation of age (pediatric patient ≥ 2 years) and diagnosis of central precocious puberty
For Lupron Depot-PED: documentation that patient is a child with central precocious puberty

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).
Central precocious puberty (CPP)
Gender-dysphoric/gender-incongruent individuals; individuals undergoing gender reassignment (as an approved non-oncology off-label compendial use)
Uterine leiomyomata (fibroids)

20 Active Policies

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

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

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

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

BCBSMS-S-5-01-446-F7FC1846A1, State and School Employees' Health Insurance Plan - Lupron (leuprolide acetate)

BCBSMS-L-5-01-446-F45068CD15, Lupron (leuprolide acetate)

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.

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

BCBSTN-53cd6a8426, Leuprolide Suspension (Lupron Depot, Leuprolide Acetate Depot)1-Month 3.75mg, 3-Month 11.25 mg)

BCBSTN-b0636a60f0, Leuprolide Acetate Depot Suspension - [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide Acetate Depot (3-month 22.5 mg): Lutrate Depot (3-month 22.5 mg)

BCBSTN-fd80a35f32, Leuprolide Acetate (Eligard, Vabrinty)

EVICORE-MEDICAL_DRUG-1CE6A4748827, Leuprolide acetate (Fensolvi, Lupron Depot-PED, Lupron Depot) Non-oncology

BCBSNM-RX502.061, Oncology Medications

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

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J1954, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 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.
Documentation of the covered diagnosis that matches one of the approved indications (e.g., CPP, gender dysphoria, fibroids, abnormal uterine bleeding, premenstrual disorders, endometriosis)
For Fensolvi: documentation of age (pediatric patient ≥ 2 years) and diagnosis of central precocious puberty
For Lupron Depot-PED: documentation that patient is a child with central precocious puberty

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).
Central precocious puberty (CPP)
Gender-dysphoric/gender-incongruent individuals; individuals undergoing gender reassignment (as an approved non-oncology off-label compendial use)
Uterine leiomyomata (fibroids)

20 Active Policies

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

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

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

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

BCBSMS-S-5-01-446-F7FC1846A1, State and School Employees' Health Insurance Plan - Lupron (leuprolide acetate)

BCBSMS-L-5-01-446-F45068CD15, Lupron (leuprolide acetate)

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.

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

BCBSTN-53cd6a8426, Leuprolide Suspension (Lupron Depot, Leuprolide Acetate Depot)1-Month 3.75mg, 3-Month 11.25 mg)

BCBSTN-fd80a35f32, Leuprolide Acetate (Eligard, Vabrinty)

EVICORE-MEDICAL_DRUG-1CE6A4748827, Leuprolide acetate (Fensolvi, Lupron Depot-PED, Lupron Depot) Non-oncology

BCBSNM-RX502.061, Oncology Medications

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

Have a follow-up question?

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

Ask Backwork about J1954 Sign up free

`J1954`, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1954`, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1954, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J1954, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J1954`, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg

`J1954`, Injection, leuprolide acetate for depot suspension (lutrate depot), 7.5 mg