Does J2327 require prior authorization?

Yes, J2327 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J2327?

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

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`J2327`, Injection, risankizumab-rzaa, intravenous, 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

Documentation of diagnosis of moderately to severely active Crohn's disease or moderately to severely active ulcerative colitis.
Documentation of patient age (≥18 years).
Documentation that Skyrizi Intravenous will be used as induction therapy and the planned induction dosing schedule.
Prescription or documentation of consultation with a gastroenterologist (prescriber specialty or consult note).
For Crohn's disease: documentation of prior therapies (names and dates) demonstrating trial of one other systemic therapy OR documentation of a trial/current use of systemic corticosteroids OR documentation of contraindication to systemic corticosteroids OR operative history documenting ileocolonic resection OR clinical documentation of enterocutaneous (perianal or abdominal) or rectovaginal fistulas.
If a prior systemic therapy is claimed, documentation that the agent was not a mesalamine product and not merely a biosimilar of the requested biologic (explicitly: a trial of a mesalamine product or a biosimilar of the requested biologic do not count as systemic therapy for Crohn's disease).

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 for Crohn’s disease: diagnosis of moderately to severely active Crohn’s disease with three intravenous induction doses of risankizumab (600 mg or 1200 mg per induction as per FDA labeling for CD), not in combination with another targeted immunomodulator, with authorization for 3 induction doses.
Moderately to severely active Crohn's disease in adults.
Moderately to severely active ulcerative colitis in adults.
For Crohn's disease: adults (≥18 years) receiving Skyrizi Intravenous as induction therapy when prescribed by or in consultation with a gastroenterologist and the individual meets one of the following: has tried one other systemic therapy for Crohn's disease (examples given: azathioprine, 6-mercaptopurine, methotrexate, adalimumab, infliximab, certolizumab, ustekinumab, vedolizumab); OR has tried or is currently taking a systemic corticosteroid; OR has a contraindication to systemic corticostero [...]
For ulcerative colitis: adults (≥18 years) receiving Skyrizi Intravenous as induction therapy when prescribed by or in consultation with a gastroenterologist.

20 Active Policies

ARKBLUE-RISANKIZUMAB-E-G-SKYRIZI-EDBE0B0619, Risankizumab (e.g., Skyrizi)

FLORIDA_BLUE-FLBLUE-SKYRIZI-IV-CRITERIA-40F29EFBEA, Skyrizi IV Criteria

BCBSLA-00677-26FB397BF1, 00677 risankizumab-rzaa (Skyrizi)

BCBSM-2164725-BB64F9B97B, SKYRIZI IV (RISANKIZUMAB-RZAA)

POINT32HEALTH-PMNG-23111, Skyrizi (risankizumab-rzaa) Subcutaneous

MULTI

MODA-SKYRIZI-IV-D57FBDCE9B, Skyrizi (risankizumab-rzaa)

IBX-MEDICARE-ADVANTAGE-MA08-153C-F36BDA3F71, Risankizumab-rzaa (Skyrizi) for intravenous use

IBX-COMMERCIAL-08-01-95C-886E33B3B9, Risankizumab-rzaa (Skyrizi) for Intravenous Use

SUREST-POL-SUREST-skyrizi, Skyrizi (Risankizumab-Rzaa)

AMERIHEALTH-COMMERCIAL-08-01-95C-ED97357197, Risankizumab-rzaa (Skyrizi) for Intravenous Use

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-153C-C0B87F857F, Risankizumab-rzaa (Skyrizi) for intravenous use

BCBSTN-cd12589262, Risankizumab-rzaa (Skyrizi)

EVICORE-MEDICAL_DRUG-7EAD816A091C, Skyrizi Intravenous (risankizumab-rzaa)

UHC-COMM-MD-SKYRIZI-RISANKIZUMAB-RZAA-COMMUNITY-PLAN-9F5C2D484B, Skyrizi (Risankizumab-Rzaa) – Community Plan Medical Benefit Drug Policy

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

UHC-EXCH-MD-SKYRIZI-RISANKIZUMAB-RZAA-COMMERCIAL-AND-EAF72CEBC2, Skyrizi (Risankizumab-Rzaa) – Commercial and Individual Exchange Medical Benefit Drug Policy

UHC-POL-skyrizi, Skyrizi (Risankizumab-Rzaa)

BCBSIL-RX501.147, Risankizumab-rzaa

BCBSMT-RX501.147, Risankizumab-rzaa

BCBSNM-RX501.147, Risankizumab-rzaa

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J2327, Injection, risankizumab-rzaa, intravenous, 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

Documentation of diagnosis of moderately to severely active Crohn's disease or moderately to severely active ulcerative colitis.
Documentation of patient age (≥18 years).
Documentation that Skyrizi Intravenous will be used as induction therapy and the planned induction dosing schedule.
Prescription or documentation of consultation with a gastroenterologist (prescriber specialty or consult note).
For Crohn's disease: documentation of prior therapies (names and dates) demonstrating trial of one other systemic therapy OR documentation of a trial/current use of systemic corticosteroids OR documentation of contraindication to systemic corticosteroids OR operative history documenting ileocolonic resection OR clinical documentation of enterocutaneous (perianal or abdominal) or rectovaginal fistulas.
If a prior systemic therapy is claimed, documentation that the agent was not a mesalamine product and not merely a biosimilar of the requested biologic (explicitly: a trial of a mesalamine product or a biosimilar of the requested biologic do not count as systemic therapy for Crohn's disease).

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 for Crohn’s disease: diagnosis of moderately to severely active Crohn’s disease with three intravenous induction doses of risankizumab (600 mg or 1200 mg per induction as per FDA labeling for CD), not in combination with another targeted immunomodulator, with authorization for 3 induction doses.
Moderately to severely active Crohn's disease in adults.
Moderately to severely active ulcerative colitis in adults.
For Crohn's disease: adults (≥18 years) receiving Skyrizi Intravenous as induction therapy when prescribed by or in consultation with a gastroenterologist and the individual meets one of the following: has tried one other systemic therapy for Crohn's disease (examples given: azathioprine, 6-mercaptopurine, methotrexate, adalimumab, infliximab, certolizumab, ustekinumab, vedolizumab); OR has tried or is currently taking a systemic corticosteroid; OR has a contraindication to systemic corticostero [...]
For ulcerative colitis: adults (≥18 years) receiving Skyrizi Intravenous as induction therapy when prescribed by or in consultation with a gastroenterologist.

20 Active Policies

ARKBLUE-RISANKIZUMAB-E-G-SKYRIZI-EDBE0B0619, Risankizumab (e.g., Skyrizi)

FLORIDA_BLUE-FLBLUE-SKYRIZI-IV-CRITERIA-40F29EFBEA, Skyrizi IV Criteria

BCBSLA-00677-26FB397BF1, 00677 risankizumab-rzaa (Skyrizi)

BCBSM-2164725-BB64F9B97B, SKYRIZI IV (RISANKIZUMAB-RZAA)

POINT32HEALTH-PMNG-23111, Skyrizi (risankizumab-rzaa) Subcutaneous

MULTI

MODA-SKYRIZI-IV-D57FBDCE9B, Skyrizi (risankizumab-rzaa)

IBX-MEDICARE-ADVANTAGE-MA08-153C-F36BDA3F71, Risankizumab-rzaa (Skyrizi) for intravenous use

IBX-COMMERCIAL-08-01-95C-886E33B3B9, Risankizumab-rzaa (Skyrizi) for Intravenous Use

SUREST-POL-SUREST-skyrizi, Skyrizi (Risankizumab-Rzaa)

AMERIHEALTH-COMMERCIAL-08-01-95C-ED97357197, Risankizumab-rzaa (Skyrizi) for Intravenous Use

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-153C-C0B87F857F, Risankizumab-rzaa (Skyrizi) for intravenous use

BCBSTN-cd12589262, Risankizumab-rzaa (Skyrizi)

EVICORE-MEDICAL_DRUG-7EAD816A091C, Skyrizi Intravenous (risankizumab-rzaa)

UHC-COMM-MD-SKYRIZI-RISANKIZUMAB-RZAA-COMMUNITY-PLAN-9F5C2D484B, Skyrizi (Risankizumab-Rzaa) – Community Plan Medical Benefit Drug Policy

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

UHC-EXCH-MD-SKYRIZI-RISANKIZUMAB-RZAA-COMMERCIAL-AND-EAF72CEBC2, Skyrizi (Risankizumab-Rzaa) – Commercial and Individual Exchange Medical Benefit Drug Policy

UHC-POL-skyrizi, Skyrizi (Risankizumab-Rzaa)

BCBSIL-RX501.147, Risankizumab-rzaa

BCBSMT-RX501.147, Risankizumab-rzaa

BCBSNM-RX501.147, Risankizumab-rzaa

Have a follow-up question?

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

Ask Backwork about J2327 Sign up free

`J2327`, Injection, risankizumab-rzaa, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2327`, Injection, risankizumab-rzaa, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2327, Injection, risankizumab-rzaa, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2327, Injection, risankizumab-rzaa, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2327`, Injection, risankizumab-rzaa, intravenous, 1 mg

`J2327`, Injection, risankizumab-rzaa, intravenous, 1 mg