Does J2802 require prior authorization?

Yes, J2802 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J2802?

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

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`J2802`, Injection, romiplostim, 1 microgram

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

Key Coverage Criteria

HS-ARS coverage criterion for Romiplostim
ITP indication requiring insufficient response to standard therapies
This policy addresses only the determination of medical necessity for the hospital outpatient setting for infusion and injectable therapy; the medical necessity of the pharmacologic or biologic medication itself may be reviewed separately.
Requests for select medications intended for administration in a hospital outpatient setting will be directed to a preferred alternative site of care (non-hospital affiliated outpatient facility or home).
Romiplostim may be medically necessary to increase survival in adults and pediatric individuals (including term neonates) acutely exposed to myelosuppressive doses of radiation (HS-ARS).
Romiplostim may be medically necessary for the treatment of thrombocytopenia in adults with ITP who had insufficient response to corticosteroids, immunoglobulins, or splenectomy; or pediatric patients 1 year and older with ITP for at least 6 months with insufficient response to corticosteroids, immunoglobulins, or splenectomy.

19 Active Policies

ARKBLUE-STEM-CELL-GROWTH-FACTOR-ROMIPLOSTIM-E-G-NPLATE-8B506540D8, Stem Cell Growth Factor, Romiplostim (e.g., Nplate)

FLORIDA_BLUE-FLBLUE-NPLATE-ROMIPLOSTIM-650D71A619, Nplate (Romiplostim)

BCBSM-2036645-2CA2483FB5, NPLATE (ROMIPLOSTIM)

BCBSND-ROMIPLOSTIM-NPLATE-793BE5F428, Romiplostim Nplate

BCBSNJ-DRUGS-062-1C16239772, Romiplostim (Nplate)

HEALTHNET_OR-HNOR-ROMIPLOSTIM-NPLATE-CP-PHAR-179-48125DEBF6, Romiplostim (Nplate); CP.PHAR.179

MODA-NPLATE-BE5DD611F3, Nplate (romiplostim)

BCBSOK-RX501.157, Romiplostim

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

BCBSTN-9448993f91, Romiplostim(Nplate)

EVICORE-MEDICAL_DRUG-42370C47F0F0, Nplate (romiplostim) Non-oncology

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

UHC-COMM-MD-NPLATE-ROMIPLOSTIM-COMMUNITY-PLAN-MEDICA-09CC09C003, Nplate (Romiplostim) – Community Plan Medical Benefit Drug Policy

BCBSIL-RX501.157, Romiplostim

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

BCBSMT-RX501.157, Romiplostim

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

BCBSNM-RX501.157, Romiplostim

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

`J2802`, Injection, romiplostim, 1 microgram

Prior Authorization

Medicare Pricing

Key Coverage Criteria

19 Active Policies

Related Codes

Have a follow-up question?

J2802, Injection, romiplostim, 1 microgram

Prior Authorization

Medicare Pricing

Key Coverage Criteria

19 Active Policies

Related Codes

Have a follow-up question?

`J2802`, Injection, romiplostim, 1 microgram