Does J3032 require prior authorization?

Yes, J3032 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J3032?

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

Backwork Sign up free

`J3032`, Injection, eptinezumab-jjmr, 1 mg

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

Authorization duration: initial and reauthorization approvals are valid for 12 months.

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.
Authorization for 6 months of preventive treatment of migraines for members aged 18 years or older is granted when the member has either chronic migraine (15-26 headache days per month, with at least 8 migraine days) or episodic migraine (4-14 headache days per month, with at least 4 migraine days).
Indication for coverage: Adults (≥18) with chronic or episodic migraine with prior preventive therapy failures, meeting specified dosing, administration setting, and prior authorization criteria.
Patient has a diagnosis of frequent episodic migraines defined as 4-14 monthly headache days per month, AND on at least 4 days per month, headaches have characteristics and symptoms consistent with migraine

20 Active Policies

ARKBLUE-EPTINEZUMAB-JJMR-E-G-VYEPTI-8CCA575C5E, Eptinezumab-jjmr (e.g., Vyepti)

FLORIDA_BLUE-FLBLUE-EPTINEZUMAB-JJMR-VYEPTITM-615672A00C, Eptinezumab-jjmr (Vyepti)

POINT32HEALTH-MDMNG-14261, Vyepti (eptinezumab-jjmr)

MULTI

HEALTHPARTNERS-CC-ENTRY-228290, Eptinezumab-jjmr (Vyepti)

MULTI

HEALTHPARTNERS-CC-ENTRY-231646, Eptinezumab-jjmr (Vyepti) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-14271, Vyepti (eptinezumab-jjmr)

MULTI

BCBSND-EPTINEZUMAB-JJMR-VYEPTI-97E1DBC670, Eptinezumab Jjmr Vyepti

BCBSNJ-DRUGS-203-5C937D381C, Eptinezumab-jjmr (Vyepti)

MODA-VYEPTI-2B402DB65E, Vyepti (eptinezumab-jjmr)

HEALTHNET_OR-HNOR-EPTINEZUMAB-JJMR-VYEPTI-CP-CPA-345-9108A69774, Eptinezumab-jjmr (Vyepti); CP.CPA.345

IBX-MEDICARE-ADVANTAGE-MA08-116E-EF9C43FADD, Eptinezumab-jjmr (VYEPTI)

IBX-COMMERCIAL-08-00-45F-9C7E257888, Eptinezumab-jjmr (VYEPTI)

UMR-POL-UMR-vyepti, Vyepti (Eptinezumab-Jjmr)

AMERIHEALTH-COMMERCIAL-08-00-45F-6A5F27B758, Eptinezumab-jjmr (VYEPTI)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-116E-DDFECD7BC3, Eptinezumab-jjmr (VYEPTI)

BCBSTN-4128adb690, Eptinezumab-jjmr (Vyepti)

EVICORE-MEDICAL_DRUG-6162DA91ED3B, Vyepti (eptinezumab-jjmr)

UHC-COMM-MD-VYEPTI-EPTINEZUMAB-JJMR-COMMUNITY-PLAN-M-D9C3E81FBE, Vyepti (Eptinezumab-Jjmr) – Community Plan Medical Benefit Drug Policy

UHC-EXCH-MD-VYEPTI-EPTINEZUMAB-JJMR-INDIVIDUAL-EXCHA-91EC036520, Vyepti (Eptinezumab-Jjmr) – Individual Exchange Medical Benefit Drug Policy

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

Have a follow-up question?

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

Ask Backwork about J3032 Sign up free

J3032, Injection, eptinezumab-jjmr, 1 mg

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

Authorization duration: initial and reauthorization approvals are valid for 12 months.

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.
Authorization for 6 months of preventive treatment of migraines for members aged 18 years or older is granted when the member has either chronic migraine (15-26 headache days per month, with at least 8 migraine days) or episodic migraine (4-14 headache days per month, with at least 4 migraine days).
Indication for coverage: Adults (≥18) with chronic or episodic migraine with prior preventive therapy failures, meeting specified dosing, administration setting, and prior authorization criteria.
Patient has a diagnosis of frequent episodic migraines defined as 4-14 monthly headache days per month, AND on at least 4 days per month, headaches have characteristics and symptoms consistent with migraine

20 Active Policies

ARKBLUE-EPTINEZUMAB-JJMR-E-G-VYEPTI-8CCA575C5E, Eptinezumab-jjmr (e.g., Vyepti)

FLORIDA_BLUE-FLBLUE-EPTINEZUMAB-JJMR-VYEPTITM-615672A00C, Eptinezumab-jjmr (Vyepti)

POINT32HEALTH-MDMNG-14261, Vyepti (eptinezumab-jjmr)

MULTI

HEALTHPARTNERS-CC-ENTRY-228290, Eptinezumab-jjmr (Vyepti)

MULTI

HEALTHPARTNERS-CC-ENTRY-231646, Eptinezumab-jjmr (Vyepti) – Minnesota Health Care Programs

MULTI

POINT32HEALTH-MDMNG-14271, Vyepti (eptinezumab-jjmr)

MULTI

BCBSND-EPTINEZUMAB-JJMR-VYEPTI-97E1DBC670, Eptinezumab Jjmr Vyepti

BCBSNJ-DRUGS-203-5C937D381C, Eptinezumab-jjmr (Vyepti)

MODA-VYEPTI-2B402DB65E, Vyepti (eptinezumab-jjmr)

HEALTHNET_OR-HNOR-EPTINEZUMAB-JJMR-VYEPTI-CP-CPA-345-9108A69774, Eptinezumab-jjmr (Vyepti); CP.CPA.345

IBX-MEDICARE-ADVANTAGE-MA08-116E-EF9C43FADD, Eptinezumab-jjmr (VYEPTI)

IBX-COMMERCIAL-08-00-45F-9C7E257888, Eptinezumab-jjmr (VYEPTI)

UMR-POL-UMR-vyepti, Vyepti (Eptinezumab-Jjmr)

AMERIHEALTH-COMMERCIAL-08-00-45F-6A5F27B758, Eptinezumab-jjmr (VYEPTI)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-116E-DDFECD7BC3, Eptinezumab-jjmr (VYEPTI)

BCBSTN-4128adb690, Eptinezumab-jjmr (Vyepti)

EVICORE-MEDICAL_DRUG-6162DA91ED3B, Vyepti (eptinezumab-jjmr)

UHC-COMM-MD-VYEPTI-EPTINEZUMAB-JJMR-COMMUNITY-PLAN-M-D9C3E81FBE, Vyepti (Eptinezumab-Jjmr) – Community Plan Medical Benefit Drug Policy

UHC-EXCH-MD-VYEPTI-EPTINEZUMAB-JJMR-INDIVIDUAL-EXCHA-91EC036520, Vyepti (Eptinezumab-Jjmr) – Individual Exchange Medical Benefit Drug Policy

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

Have a follow-up question?

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

Ask Backwork about J3032 Sign up free

`J3032`, Injection, eptinezumab-jjmr, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J3032`, Injection, eptinezumab-jjmr, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J3032, Injection, eptinezumab-jjmr, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J3032, Injection, eptinezumab-jjmr, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J3032`, Injection, eptinezumab-jjmr, 1 mg

`J3032`, Injection, eptinezumab-jjmr, 1 mg