Does J3240 require prior authorization?

Yes, J3240 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J3240?

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

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`J3240`, Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial

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 adjunctive use in non-toxic multinodular goiter: documentation that Thyrogen is being used as an adjunct to radioiodine ablation.
When Tg testing is planned, documentation of anti-Tg antibody status should be available, given that anti-Tg antibodies may render Tg levels uninterpretable

For replacement of thyroid hormone withdrawal: documentation that the member cannot undergo thyroid hormone withdrawal (e.g., contraindication to withdrawal) or is unwilling to undergo withdrawal and the treating physician's statement that use of a less sensitive test is justified.

Key Coverage Criteria

HCPCS J3240 (Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial) when selection criteria are met
ICD-10 diagnoses covered if selection criteria are met: C73 (Malignant neoplasm of thyroid gland) [except for suppressed serum thyroglobulin (less than 0.1 ng/ml)], E04.2 (Nontoxic multinodular goiter) [adjunct to radioiodine ablation], Z85.850 (Personal history of malignant neoplasm of thyroid)
For thyroglobulin (Tg) testing and radioiodine imaging in place of thyroid hormone withdrawal for any of the following groups with differentiated thyroid carcinoma:
Members in whom withdrawal from hormone supplement is contraindicated for medical reasons;
Members requiring serum Tg testing and radioiodine imaging who are unwilling to undergo thyroid hormone withdrawal testing and whose treating physician believes that use of a less sensitive test is justified;
Members who are either unable to mount an adequate endogenous thyroid stimulating hormone (TSH) response to thyroid hormone withdrawal;

4 Active Policies

AETNA-CPB-0515, Thyrogen (Thyrotropin Alfa)

BCBSTN-b71aab37ab, Thyrotropin Alfa (Thyrogen)

OSCAR-THYROGEN-THYROTROPIN-ALFA-PG140-VER-3-524680B65D, Thyrogen (thyrotropin alfa) (PG140, Ver. 3)

OSCAR-THYROGEN-THYROTROPIN-ALFA-PG140-VER-4-6F577B57E1, Thyrogen (thyrotropin alfa) (PG140, Ver. 4)

`J3240`, Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

J3240, Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

4 Active Policies

Related Codes

Have a follow-up question?

`J3240`, Injection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial