Does J2329 require prior authorization?

Yes, J2329 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J2329?

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

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`J2329`, Injection, ublituximab-xiiy, 1mg

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

For initial therapy: documentation of diagnosis of relapsing forms of multiple sclerosis (MS) (e.g., relapsing-remitting MS, secondary-progressive MS with relapses, progressive-relapsing MS with relapses).
For initial therapy: documentation that patient is not receiving Briumvi in combination with the listed disease modifying therapies, B cell targeted therapies, or lymphocyte trafficking blockers.
For initial therapy: documentation that Briumvi dosing will be in accordance with the United States Food and Drug Administration approved labeling (dosing schedule: 150 mg first infusion, 450 mg two weeks after first infusion, then 450 mg every 24 weeks).
For continuation of therapy: documentation that the patient has previously received Briumvi.
For continuation of therapy: documentation of positive clinical response to Briumvi therapy.
For continuation of therapy: documentation that the patient is not receiving Briumvi in combination with the listed disease modifying therapies, B cell targeted therapies, or lymphocyte trafficking blockers, and that dosing remains consistent with FDA labeling.

Key Coverage Criteria

Briumvi (ublituximab-xiiy) is proven for the treatment of relapsing forms of multiple sclerosis (MS).
For initial therapy, all of the following: Diagnosis of relapsing forms of multiple sclerosis (MS) (e.g., relapsing-remitting MS, secondary-progressive MS with relapses, progressive-relapsing MS with relapses); and Patient is not receiving Briumvi in combination with any of the following: Disease modifying therapy (e.g., interferon beta preparations, glatiramer acetate, natalizumab, fingolimod, cladribine, siponimod, or teriflunomide) B cell targeted therapy (e.g., rituximab, belimumab, ofatumum [...]
For continuation of therapy, all of the following: Patient has previously received treatment with Briumvi; and Documentation of positive clinical response to Briumvi therapy; and Patient is not receiving Briumvi in combination with any of the following: Disease modifying therapy (e.g., interferon beta preparations, dimethyl fumarate, glatiramer acetate, natalizumab, fingolimod, cladribine, siponimod, or teriflunomide) B cell targeted therapy (e.g., rituximab, belimumab, ofatumumab, ocrelizumab) [...]
FDA indication (informational): Briumvi is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
Covered ICD-10 diagnosis codes listed in the policy as referenced (for coverage consideration): G35.A (Relapsing-remitting multiple sclerosis), G35.B0 (Primary progressive multiple sclerosis, unspecified), G35.B1 (Active primary progressive multiple sclerosis), G35.B2 (Non-active primary progressive multiple sclerosis), G35.C0 (Secondary progressive multiple sclerosis, unspecified), G35.C1 (Active secondary progressive multiple sclerosis), G35.C2 (Non-active secondary progressive multiple sclero [...]
Applicable HCPCS code for billing reference: J2329 Injection, ublituximab-xiiy, 1mg.

20 Active Policies

ARKBLUE-UBLITUXIMAB-XIIY-E-G-BRIUMVI-C815BEFBDE, Ublituximab-xiiy (e.g., Briumvi)

FLORIDA_BLUE-FLBLUE-BRIUMVI-UBLITUXIMAB-AB2925A94F, Briumvi (ublituximab)

BCBSLA-00838-96BB0D5741, 00838 ublituximab (Briumvi)

HEALTHPARTNERS-CC-ENTRY-260878, Ublituximab-xiiy (Briumvi)

MULTI

MODA-BRIUMVI-D7AC189839, Briumvi (ublituximab-xiiy)

HEALTHNET_OR-HNOR-UBLITUXIMAB-XIIY-BRIUMVI-CP-PHAR-621-1D19BC97E0, Ublituximab-xiiy (Briumvi); CP.PHAR.621

IBX-COMMERCIAL-08-02-02B-2C14A94DC1, Ublituximab-xiiy (Briumvi) for intravenous use

IBX-MEDICARE-ADVANTAGE-MA08-160B-8EBFB99C82, Ublituximab-xiiy (Briumvi ) for intravenous use

SUREST-POL-SUREST-briumvi, Briumvi (Ublituximab-Xiiy)

AMERIHEALTH-COMMERCIAL-08-02-02B-BA98C8995A, Ublituximab-xiiy (Briumvi) for intravenous use

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-160B-B196142ADE, Ublituximab-xiiy (Briumvi ) for intravenous use

BCBSTN-6e907f0afc, Multiple Sclerosis Products:(Ocrelizumab [Ocrevus], Ocrelizumab and Hyaluronidase-ocsq [Ocrevus Zunovo], Ublituximab-xiiy [Briumvi])

EVICORE-MEDICAL_DRUG-BF9BD15A069D, Briumvi (ublituximab-xiiy) Intravenous Injection

OSCAR-BRIUMVI-UBLITUXIMAB-PG134-VER-6-D7ED19208A, Briumvi (ublituximab) (PG134, Ver. 6)

UHC-COMM-MD-BRIUMVI-UBLITUXIMAB-XIIY-COMMUNITY-PLAN-2FFE958405, Briumvi (Ublituximab-Xiiy) – Community Plan Medical Benefit Drug Policy

UHC-EXCH-MD-BRIUMVI-UBLITUXIMAB-XIIY-INDIVIDUAL-EXCH-AB31F209D1, Briumvi (Ublituximab-Xiiy) – Individual Exchange Medical Benefit Drug Policy

BCBSIL-RX501.153, Ublituximab-xiiy

BCBSMT-RX501.153, Ublituximab-xiiy

BCBSNM-RX501.153, Ublituximab-xiiy

UHC-POL-briumvi, Briumvi (Ublituximab-Xiiy)

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J2329, Injection, ublituximab-xiiy, 1mg

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

For initial therapy: documentation of diagnosis of relapsing forms of multiple sclerosis (MS) (e.g., relapsing-remitting MS, secondary-progressive MS with relapses, progressive-relapsing MS with relapses).
For initial therapy: documentation that patient is not receiving Briumvi in combination with the listed disease modifying therapies, B cell targeted therapies, or lymphocyte trafficking blockers.
For initial therapy: documentation that Briumvi dosing will be in accordance with the United States Food and Drug Administration approved labeling (dosing schedule: 150 mg first infusion, 450 mg two weeks after first infusion, then 450 mg every 24 weeks).
For continuation of therapy: documentation that the patient has previously received Briumvi.
For continuation of therapy: documentation of positive clinical response to Briumvi therapy.
For continuation of therapy: documentation that the patient is not receiving Briumvi in combination with the listed disease modifying therapies, B cell targeted therapies, or lymphocyte trafficking blockers, and that dosing remains consistent with FDA labeling.

Key Coverage Criteria

Briumvi (ublituximab-xiiy) is proven for the treatment of relapsing forms of multiple sclerosis (MS).
For initial therapy, all of the following: Diagnosis of relapsing forms of multiple sclerosis (MS) (e.g., relapsing-remitting MS, secondary-progressive MS with relapses, progressive-relapsing MS with relapses); and Patient is not receiving Briumvi in combination with any of the following: Disease modifying therapy (e.g., interferon beta preparations, glatiramer acetate, natalizumab, fingolimod, cladribine, siponimod, or teriflunomide) B cell targeted therapy (e.g., rituximab, belimumab, ofatumum [...]
For continuation of therapy, all of the following: Patient has previously received treatment with Briumvi; and Documentation of positive clinical response to Briumvi therapy; and Patient is not receiving Briumvi in combination with any of the following: Disease modifying therapy (e.g., interferon beta preparations, dimethyl fumarate, glatiramer acetate, natalizumab, fingolimod, cladribine, siponimod, or teriflunomide) B cell targeted therapy (e.g., rituximab, belimumab, ofatumumab, ocrelizumab) [...]
FDA indication (informational): Briumvi is indicated for the treatment of relapsing forms of multiple sclerosis (MS), to include clinically isolated syndrome, relapsing-remitting disease, and active secondary progressive disease, in adults.
Covered ICD-10 diagnosis codes listed in the policy as referenced (for coverage consideration): G35.A (Relapsing-remitting multiple sclerosis), G35.B0 (Primary progressive multiple sclerosis, unspecified), G35.B1 (Active primary progressive multiple sclerosis), G35.B2 (Non-active primary progressive multiple sclerosis), G35.C0 (Secondary progressive multiple sclerosis, unspecified), G35.C1 (Active secondary progressive multiple sclerosis), G35.C2 (Non-active secondary progressive multiple sclero [...]
Applicable HCPCS code for billing reference: J2329 Injection, ublituximab-xiiy, 1mg.

20 Active Policies

ARKBLUE-UBLITUXIMAB-XIIY-E-G-BRIUMVI-C815BEFBDE, Ublituximab-xiiy (e.g., Briumvi)

FLORIDA_BLUE-FLBLUE-BRIUMVI-UBLITUXIMAB-AB2925A94F, Briumvi (ublituximab)

BCBSLA-00838-96BB0D5741, 00838 ublituximab (Briumvi)

HEALTHPARTNERS-CC-ENTRY-260878, Ublituximab-xiiy (Briumvi)

MULTI

MODA-BRIUMVI-D7AC189839, Briumvi (ublituximab-xiiy)

HEALTHNET_OR-HNOR-UBLITUXIMAB-XIIY-BRIUMVI-CP-PHAR-621-1D19BC97E0, Ublituximab-xiiy (Briumvi); CP.PHAR.621

IBX-COMMERCIAL-08-02-02B-2C14A94DC1, Ublituximab-xiiy (Briumvi) for intravenous use

IBX-MEDICARE-ADVANTAGE-MA08-160B-8EBFB99C82, Ublituximab-xiiy (Briumvi ) for intravenous use

SUREST-POL-SUREST-briumvi, Briumvi (Ublituximab-Xiiy)

AMERIHEALTH-COMMERCIAL-08-02-02B-BA98C8995A, Ublituximab-xiiy (Briumvi) for intravenous use

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-160B-B196142ADE, Ublituximab-xiiy (Briumvi ) for intravenous use

BCBSTN-6e907f0afc, Multiple Sclerosis Products:(Ocrelizumab [Ocrevus], Ocrelizumab and Hyaluronidase-ocsq [Ocrevus Zunovo], Ublituximab-xiiy [Briumvi])

EVICORE-MEDICAL_DRUG-BF9BD15A069D, Briumvi (ublituximab-xiiy) Intravenous Injection

OSCAR-BRIUMVI-UBLITUXIMAB-PG134-VER-6-D7ED19208A, Briumvi (ublituximab) (PG134, Ver. 6)

UHC-COMM-MD-BRIUMVI-UBLITUXIMAB-XIIY-COMMUNITY-PLAN-2FFE958405, Briumvi (Ublituximab-Xiiy) – Community Plan Medical Benefit Drug Policy

UHC-EXCH-MD-BRIUMVI-UBLITUXIMAB-XIIY-INDIVIDUAL-EXCH-AB31F209D1, Briumvi (Ublituximab-Xiiy) – Individual Exchange Medical Benefit Drug Policy

BCBSIL-RX501.153, Ublituximab-xiiy

BCBSMT-RX501.153, Ublituximab-xiiy

BCBSNM-RX501.153, Ublituximab-xiiy

UHC-POL-briumvi, Briumvi (Ublituximab-Xiiy)

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

Ask Backwork about J2329 Sign up free

`J2329`, Injection, ublituximab-xiiy, 1mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2329`, Injection, ublituximab-xiiy, 1mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2329, Injection, ublituximab-xiiy, 1mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2329, Injection, ublituximab-xiiy, 1mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2329`, Injection, ublituximab-xiiy, 1mg

`J2329`, Injection, ublituximab-xiiy, 1mg