Does J2354 require prior authorization?

Yes, J2354 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J2354?

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

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`J2354`, Injection, octreotide, non-depot form for subcutaneous or intravenous

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 a prior trial with short-acting subcutaneous octreotide demonstrating clinical effectiveness and tolerability is required before coverage of long-acting octreotide.
For acromegaly, documentation of baseline and post-treatment GH and/or IGF-1 levels consistent with therapeutic goals (reduction toward normal) is expected per FDA treatment intent.
For chemotherapy-induced diarrhea, documentation that oral antidiarrheal agents (for example, loperamide) were tried and found ineffective is required.
Administration must be performed under direct physician supervision and recorded in medical records (site of injection, dosing, and supervising physician).
Cancer-related diarrhea: Chart notes indicating grade 3 or 4 diarrhea.
For initial approval: Laboratory report indicating high pretreatment insulin-like growth factor-1 (IGF-1) level and chart notes indicating an inadequate or partial response to surgery or radiotherapy or a clinical reason for not having surgery or radiotherapy.

Key Coverage Criteria

Long-acting octreotide acetate (Sandostatin LAR) is covered for reduction of growth hormone (GH) and IGF-1 in patients with acromegaly who are appropriate for medical treatment and who have demonstrated response to and tolerability of short-acting subcutaneous octreotide.
Long-acting octreotide acetate is covered for suppression of severe diarrhea and flushing associated with malignant carcinoid syndrome when initial treatment with short-acting subcutaneous octreotide has been effective and tolerated.
Long-acting octreotide acetate is covered for long-term treatment of profuse watery diarrhea associated with vasoactive intestinal peptide (VIP)-secreting tumors when initial short-acting subcutaneous octreotide therapy has been effective and tolerated.
Octreotide is covered for chemotherapy-induced diarrhea (CID) when oral antidiarrheal medications (e.g., loperamide) have been ineffective.
Indication: Acromegaly in patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or dopamine agonist at maximally tolerated doses.
Indication: Long-term maintenance therapy in acromegalic patients who have shown response to and can tolerate octreotide acetate injection.

20 Active Policies

ARKBLUE-OCTREOTIDE-ACETATE-E-G-SANDOSTATIN-FOR-INJECTABL-2E9A8D92BF, Octreotide Acetate (e.g., Sandostatin) for Injectable Suspension (e.g., Sandostatin LAR Depot)

HEALTHPARTNERS-CC-AENTRY-046147, Somatostatin analogues for acromegaly (Sandostatin LAR, Somatuline Depot, Signifor LAR, Somavert, Lanreotide)

MULTI

BCBSNJ-DRUGS-118-6096E061EB, Sandostatin, Sandostatin LAR depot (Octreotide), Somatuline Depo (lanreotide), Signifor LAR (pasireotide)

MODA-OCTREOTIDE-03B27C73B7, Sandostatin LAR (octreotide suspension)

HEALTHNET_OR-HNOR-OCTREOTIDE-ACETATE-SANDOSTATIN-SANDOSTATIN-LAR-MYCAPSSA-00E7CF9A18, Octreotide Acetate (Sandostatin, Sandostatin LAR, Mycapssa); CP.PHAR.40

IBX-MEDICARE-ADVANTAGE-MA08-065L-E51551DDA4, Octreotide Acetate (Sandostatin LAR Depot)

IBX-MA-PPO-HOST-MA08-065I-899CA07BB8, Octreotide Acetate (Sandostatin LAR Depot)

IBX-COMMERCIAL-08-01-10L-35F73BF6DD, Octreotide Acetate (Sandostatin LAR Depot)

BCBSNM-RX501.156, Octreotide

BCBSNM-ADM1001.034, Specialty Medication Administration Site of Care

BCBSOK-RX501.156, Octreotide

BCBSOK-ADM1001.034, Specialty Medication Administration Site of Care

UMR-POL-UMR-somatostatin-analogs, Somatostatin Analogs

SUREST-POL-SUREST-somatostatin-analogs, Somatostatin Analogs

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

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-065L-55A6DA2B98, Octreotide Acetate (Sandostatin LAR Depot)

BCBSTN-0d4fcba8ff, Octreotide Suspension (Sandostatin LAR Depot), Octreotide Acetate for Injectable Suspension

BCBSTX-RX501.156, Octreotide acetate

EVICORE-MEDICAL_DRUG-B13360414DE6, Octreotide Acetate Long-acting Products (Sandostatin LAR Depot, generic) - non-oncology

L33438, Octreotide Acetate for Injectable Suspension (Sandostatin LAR Depot)

Have a follow-up question?

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

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J2354, Injection, octreotide, non-depot form for subcutaneous or intravenous

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 a prior trial with short-acting subcutaneous octreotide demonstrating clinical effectiveness and tolerability is required before coverage of long-acting octreotide.
For acromegaly, documentation of baseline and post-treatment GH and/or IGF-1 levels consistent with therapeutic goals (reduction toward normal) is expected per FDA treatment intent.
For chemotherapy-induced diarrhea, documentation that oral antidiarrheal agents (for example, loperamide) were tried and found ineffective is required.
Administration must be performed under direct physician supervision and recorded in medical records (site of injection, dosing, and supervising physician).
Cancer-related diarrhea: Chart notes indicating grade 3 or 4 diarrhea.
For initial approval: Laboratory report indicating high pretreatment insulin-like growth factor-1 (IGF-1) level and chart notes indicating an inadequate or partial response to surgery or radiotherapy or a clinical reason for not having surgery or radiotherapy.

Key Coverage Criteria

Long-acting octreotide acetate (Sandostatin LAR) is covered for reduction of growth hormone (GH) and IGF-1 in patients with acromegaly who are appropriate for medical treatment and who have demonstrated response to and tolerability of short-acting subcutaneous octreotide.
Long-acting octreotide acetate is covered for suppression of severe diarrhea and flushing associated with malignant carcinoid syndrome when initial treatment with short-acting subcutaneous octreotide has been effective and tolerated.
Long-acting octreotide acetate is covered for long-term treatment of profuse watery diarrhea associated with vasoactive intestinal peptide (VIP)-secreting tumors when initial short-acting subcutaneous octreotide therapy has been effective and tolerated.
Octreotide is covered for chemotherapy-induced diarrhea (CID) when oral antidiarrheal medications (e.g., loperamide) have been ineffective.
Indication: Acromegaly in patients who have had inadequate response to or cannot be treated with surgical resection, pituitary irradiation, or dopamine agonist at maximally tolerated doses.
Indication: Long-term maintenance therapy in acromegalic patients who have shown response to and can tolerate octreotide acetate injection.

20 Active Policies

ARKBLUE-OCTREOTIDE-ACETATE-E-G-SANDOSTATIN-FOR-INJECTABL-2E9A8D92BF, Octreotide Acetate (e.g., Sandostatin) for Injectable Suspension (e.g., Sandostatin LAR Depot)

HEALTHPARTNERS-CC-AENTRY-046147, Somatostatin analogues for acromegaly (Sandostatin LAR, Somatuline Depot, Signifor LAR, Somavert, Lanreotide)

MULTI

BCBSNJ-DRUGS-118-6096E061EB, Sandostatin, Sandostatin LAR depot (Octreotide), Somatuline Depo (lanreotide), Signifor LAR (pasireotide)

MODA-OCTREOTIDE-03B27C73B7, Sandostatin LAR (octreotide suspension)

HEALTHNET_OR-HNOR-OCTREOTIDE-ACETATE-SANDOSTATIN-SANDOSTATIN-LAR-MYCAPSSA-00E7CF9A18, Octreotide Acetate (Sandostatin, Sandostatin LAR, Mycapssa); CP.PHAR.40

IBX-MEDICARE-ADVANTAGE-MA08-065L-E51551DDA4, Octreotide Acetate (Sandostatin LAR Depot)

IBX-MA-PPO-HOST-MA08-065I-899CA07BB8, Octreotide Acetate (Sandostatin LAR Depot)

IBX-COMMERCIAL-08-01-10L-35F73BF6DD, Octreotide Acetate (Sandostatin LAR Depot)

BCBSNM-RX501.156, Octreotide

BCBSNM-ADM1001.034, Specialty Medication Administration Site of Care

BCBSOK-RX501.156, Octreotide

BCBSOK-ADM1001.034, Specialty Medication Administration Site of Care

UMR-POL-UMR-somatostatin-analogs, Somatostatin Analogs

SUREST-POL-SUREST-somatostatin-analogs, Somatostatin Analogs

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

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-065L-55A6DA2B98, Octreotide Acetate (Sandostatin LAR Depot)

BCBSTN-0d4fcba8ff, Octreotide Suspension (Sandostatin LAR Depot), Octreotide Acetate for Injectable Suspension

BCBSTX-RX501.156, Octreotide acetate

EVICORE-MEDICAL_DRUG-B13360414DE6, Octreotide Acetate Long-acting Products (Sandostatin LAR Depot, generic) - non-oncology

L33438, Octreotide Acetate for Injectable Suspension (Sandostatin LAR Depot)

Have a follow-up question?

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

Ask Backwork about J2354 Sign up free

`J2354`, Injection, octreotide, non-depot form for subcutaneous or intravenous

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2354`, Injection, octreotide, non-depot form for subcutaneous or intravenous

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2354, Injection, octreotide, non-depot form for subcutaneous or intravenous

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J2354, Injection, octreotide, non-depot form for subcutaneous or intravenous

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J2354`, Injection, octreotide, non-depot form for subcutaneous or intravenous

`J2354`, Injection, octreotide, non-depot form for subcutaneous or intravenous