Does J2182 require prior authorization?

Yes, J2182 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J2182?

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

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`J2182`, Injection, mepolizumab, 1 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation of positive clinical response as demonstrated by at least one of the following: o Reduction in the frequency of exacerbations o Decreased utilization of rescue medications o Increase in percent predicted FEV1 from pretreatment baseline o Reduction in severity or frequency of asthma-related symptoms

Key Coverage Criteria

Covered when hospital outpatient facility infusion services for specialty medications and IVIG/SCIG therapy are considered medically necessary and the member meets the specific clinical criteria described in the policy.
Indication: Add-on maintenance treatment of severe asthma in patients aged 6 years and older with eosinophilic phenotype.
Indication: Treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA).
Indication: Add-on maintenance treatment of CRSwNP in adults (18+)
Indication: Add-on maintenance treatment of adults with COPD and eosinophilic phenotype
Nucala for provider administration is proven for add-on therapy for patients who meet both of the following criteria: o Has an eosinophilic phenotype; and o Will be used as add-on maintenance therapy in the treatment of severe asthma

20 Active Policies

FLORIDA_BLUE-FLBLUE-MEPOLIZUMAB-NUCALA-28FBEB90D6, Mepolizumab (Nucala)

BCBSLA-00501-87657E7951, 00501 mepolizumab (Nucala)

BCBSM-2071699-777EA6CE52, NUCALA (MEPOLIZUMAB)

POINT32HEALTH-PMNG-17056, Nucala (mepolizumab) Pre-filled Autoinjector and Syringe

MULTI

POINT32HEALTH-PMNG-17066, Nucala (mepolizumab) Pre-filled Autoinjector and Syringe

MULTI

POINT32HEALTH-PMNG-27791, Nucala (mepolizumab) Pre-filled Autoinjector and Syringe

MULTI

BCBSNJ-DRUGS-133-2ADC519856, Monoclonal Interleukin-5 Antagonists [mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra)]

HEALTHNET_OR-HNOR-MEPOLIZUMAB-NUCALA-CP-PHAR-200-7B41C5A46E, Mepolizumab (Nucala); CP.PHAR.200

MODA-NUCALA-50AD8311B5, Nucala (mepolizumab)

IBX-MEDICARE-ADVANTAGE-MA08-024O-D2920CA97B, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

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

UMR-POL-UMR-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

SUREST-POL-SUREST-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-024O-19BF620A89, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

BCBSTN-677583cb04, Mepolizumab (Nucala)

EVICORE-MEDICAL_DRUG-998122971F44, Nucala (mepolizumab)Effective 10/01/2026

EVICORE-MEDICAL_DRUG-AC94FFD9709B, Nucala (mepolizumab)

UHC-COMM-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-3476B9F5B6, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Community Plan Medical Benefit Drug Policy

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

UHC-EXCH-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-0A5E0CE7F5, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Individual Exchange Medical Benefit Drug Policy

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J2182, Injection, mepolizumab, 1 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Documentation of positive clinical response as demonstrated by at least one of the following: o Reduction in the frequency of exacerbations o Decreased utilization of rescue medications o Increase in percent predicted FEV1 from pretreatment baseline o Reduction in severity or frequency of asthma-related symptoms

Key Coverage Criteria

Covered when hospital outpatient facility infusion services for specialty medications and IVIG/SCIG therapy are considered medically necessary and the member meets the specific clinical criteria described in the policy.
Indication: Add-on maintenance treatment of severe asthma in patients aged 6 years and older with eosinophilic phenotype.
Indication: Treatment of adult patients with eosinophilic granulomatosis with polyangiitis (EGPA).
Indication: Add-on maintenance treatment of CRSwNP in adults (18+)
Indication: Add-on maintenance treatment of adults with COPD and eosinophilic phenotype
Nucala for provider administration is proven for add-on therapy for patients who meet both of the following criteria: o Has an eosinophilic phenotype; and o Will be used as add-on maintenance therapy in the treatment of severe asthma

20 Active Policies

FLORIDA_BLUE-FLBLUE-MEPOLIZUMAB-NUCALA-28FBEB90D6, Mepolizumab (Nucala)

BCBSLA-00501-87657E7951, 00501 mepolizumab (Nucala)

BCBSM-2071699-777EA6CE52, NUCALA (MEPOLIZUMAB)

POINT32HEALTH-PMNG-17056, Nucala (mepolizumab) Pre-filled Autoinjector and Syringe

MULTI

POINT32HEALTH-PMNG-17066, Nucala (mepolizumab) Pre-filled Autoinjector and Syringe

MULTI

POINT32HEALTH-PMNG-27791, Nucala (mepolizumab) Pre-filled Autoinjector and Syringe

MULTI

BCBSNJ-DRUGS-133-2ADC519856, Monoclonal Interleukin-5 Antagonists [mepolizumab (Nucala), reslizumab (Cinqair), and benralizumab (Fasenra)]

HEALTHNET_OR-HNOR-MEPOLIZUMAB-NUCALA-CP-PHAR-200-7B41C5A46E, Mepolizumab (Nucala); CP.PHAR.200

MODA-NUCALA-50AD8311B5, Nucala (mepolizumab)

IBX-MEDICARE-ADVANTAGE-MA08-024O-D2920CA97B, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

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

UMR-POL-UMR-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

SUREST-POL-SUREST-respiratory-interleukins, Respiratory Interleukins (Cinqair, Fasenra, & Nucala)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-024O-19BF620A89, Interleukin-5 (IL-5) Antagonist (e.g., Cinqair, Exdensur, Nucala) and IL-5 Receptor Antagonist (e.g., Fasenra)

BCBSTN-677583cb04, Mepolizumab (Nucala)

EVICORE-MEDICAL_DRUG-998122971F44, Nucala (mepolizumab)Effective 10/01/2026

EVICORE-MEDICAL_DRUG-AC94FFD9709B, Nucala (mepolizumab)

UHC-COMM-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-3476B9F5B6, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Community Plan Medical Benefit Drug Policy

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

UHC-EXCH-MD-RESPIRATORY-INTERLEUKINS-CINQAIR-FASENRA-0A5E0CE7F5, Respiratory Interleukins (Cinqair, Fasenra, & Nucala) – Individual Exchange Medical Benefit Drug Policy

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

Ask Backwork about J2182 Sign up free

`J2182`, Injection, mepolizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2182`, Injection, mepolizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2182, Injection, mepolizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2182, Injection, mepolizumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2182`, Injection, mepolizumab, 1 mg

`J2182`, Injection, mepolizumab, 1 mg