Does J2501 require prior authorization?

Yes, J2501 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J2501?

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

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`J2501`, Injection, paricalcitol, 1 mcg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Conditional coverage; review criteria to confirm PA need (medium confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

For NB-UVB: documentation of phototherapy course, frequency (2–3 times per week) and cumulative number of treatments (UpToDate cited up to 200 treatments for some courses).
For excimer laser: documentation of treatment frequency and number of sessions (typically twice weekly; up to 60 treatments may generally be medically necessary for excimer laser).

For surgical grafting/epidermal transplantation: documentation of stability of disease (e.g., stable vitiligo), failure or intolerance of standard/medical therapies, and informed consent; evidence in the text specifies surgical techniques are effective in stable cases and that epidermal grafting is used in "stable localized vitiligo unresponsive to standard therapies."

Key Coverage Criteria

Surgical epidermal grafting / epidermal harvesting techniques (including automated suction blister epidermal graft [SBEG] devices and other epidermal harvesting systems) have been used for stable localized vitiligo and may be effective in patients with stable vitiligo unresponsive to standard therapies.
Fractional CO2 laser in combination with topical tacrolimus may be an effective adjunctive therapy for some patients (especially progressing disease per the cited preliminary studies).
Combination therapies with NB-UVB plus adjuncts (e.g., topical tacrolimus, needling/micro-needling, Er:YAG laser + topical 5% 5-FU, betamethasone intramuscular injection, carboxytherapy, certain Chinese herbal compounds) have been reported to be more effective than NB-UVB alone in some trials / meta-analyses.
ICD-10 diagnosis covered if selection criteria are met: L80 (Vitiligo).
Treatment of vitiligo using the following established methods: Excimer laser (e.g., XTRAC, PhotoMedex, Radnor, PA; EX-308, Ra Medical Systems, Inc., Carlsbad, CA).
Treatment of vitiligo using Narrow-band ultraviolet B (NB-UVB).

2 Active Policies

HEALTHNET_OR-HNOR-PARICALCITOL-INJECTION-ZEMPLAR-CP-PHAR-270-F753C39FDA, Paricalcitol Injection (Zemplar); CP.PHAR.270

AETNA-CPB-0422, Vitiligo

`J2501`, Injection, paricalcitol, 1 mcg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

J2501, Injection, paricalcitol, 1 mcg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

2 Active Policies

Related Codes

Have a follow-up question?

`J2501`, Injection, paricalcitol, 1 mcg