Does J3247 require prior authorization?

Yes, J3247 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J3247?

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

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`J3247`, Injection, secukinumab, intravenous, 1 mg

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

Justification why IV route is medically reasonable and necessary (explicit explanation required in request).
Prescriber attestation that patient or caregiver cannot be trained or are physically unable to administer the FDA‑labeled self‑administered (subcutaneous) Cosentyx, plus supporting medical records and/or justification explanation.
For prior targeted immunomodulator use: documentation of drug name, dates of therapy, and duration (claims history or medical records).
For prior methotrexate trial (PsA initial therapy): documentation of 3‑month trial at maximally indicated dose or documentation of contraindication/intolerance.
For prior NSAID trials (AS / nr‑axSpA initial therapy): documentation of two NSAIDs each used for ≥4 weeks at maximally indicated doses or documentation of contraindication/intolerance.
Documentation of initiation and titration per U.S. FDA‑labeled dosing for the relevant indication (PsA, AS, or nr‑axSpA).

Key Coverage Criteria

Intravenous Cosentyx (secukinumab) for administration by a healthcare professional is medically necessary for adult patients with active psoriatic arthritis (PsA) when all applicable criteria below are met.
For initial PsA therapy: diagnosis of active psoriatic arthritis; Cosentyx is initiated and titrated according to U.S. FDA‑labeled dosing for PsA; patient is not receiving Cosentyx in combination with a targeted immunomodulator (examples listed in policy); prescribed by or in consultation with a rheumatologist or dermatologist; initial authorization issued for 12 months.
For initial PsA therapy — additional prerequisites (one of the following must be met): history of failure to a 3‑month trial of methotrexate at the maximally indicated dose unless contraindicated or intolerant; OR prior treatment with a targeted immunomodulator FDA‑approved for PsA (document drug, date, duration).
For PsA continuation of therapy: documentation of positive clinical response; Cosentyx continued per FDA‑labeled dosing for PsA; patient is not receiving Cosentyx in combination with a targeted immunomodulator; authorization issued for 12 months.
Intravenous Cosentyx is medically necessary for adult patients with active ankylosing spondylitis (AS) or non‑radiographic axial spondyloarthritis (nr‑axSpA) when all applicable criteria below are met.
For initial AS / nr‑axSpA therapy: diagnosis of active ankylosing spondylitis or non‑radiographic axial spondyloarthritis; Cosentyx is initiated and titrated according to U.S. FDA‑labeled dosing for AS or nr‑axSpA; patient is not receiving Cosentyx in combination with a targeted immunomodulator (examples listed in policy); prescribed by or in consultation with a rheumatologist; initial authorization issued for 12 months.

20 Active Policies

ARKBLUE-SECUKINUMAB-E-G-COSENTYX-9C67F432D7, Secukinumab (e.g., Cosentyx)

FLORIDA_BLUE-FLBLUE-COSENTYX-IV-CF8E40A027, Cosentyx IV

BCBSLA-00432-06AF1238E9, 00432 secukinumab (Cosentyx)

BCBSM-2049834-7F1742A67D, COSENTYX (SECUKINUMAB)

POINT32HEALTH-PMNG-24526, Cosentyx (secukinumab)

MULTI

MODA-COSENTYX-150DE10D7A, Cosentyx (secukinumab)

IBX-MEDICARE-ADVANTAGE-MA08-174-221236E5B6, Secukinumab (Cosentyx) for Intravenous Use

IBX-COMMERCIAL-08-02-28-59C84D7811, Secukinumab (Cosentyx) for Intravenous Use

BCBSOK-RX501.169, Secukinumab

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

UMR-POL-UMR-cosentyx, Cosentyx (Secukinumab)

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

SUREST-POL-SUREST-cosentyx, Cosentyx (Secukinumab)

AMERIHEALTH-COMMERCIAL-08-02-28-46483A85C8, Secukinumab (Cosentyx) for Intravenous Use

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-174-EEC9AB5595, Secukinumab (Cosentyx) for Intravenous Use

BCBSTN-c538afca30, Secukinumab (Cosentyx)

EVICORE-MEDICAL_DRUG-42E469CA5D41, Cosentyx Intravenous (secukinumab)

UHC-COMM-MD-COSENTYX-SECUKINUMAB-COMMUNITY-PLAN-MEDI-A09EC3C5D5, Cosentyx (Secukinumab) – Community Plan Medical Benefit Drug Policy

UHC-POL-cosentyx, Cosentyx (Secukinumab)

UHC-EXCH-MD-COSENTYX-SECUKINUMAB-INDIVIDUAL-EXCHANGE-612CF582F6, Cosentyx (Secukinumab) – Individual Exchange Medical Benefit Drug Policy

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

Ask Backwork about J3247 Sign up free

J3247, Injection, secukinumab, intravenous, 1 mg

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

Justification why IV route is medically reasonable and necessary (explicit explanation required in request).
Prescriber attestation that patient or caregiver cannot be trained or are physically unable to administer the FDA‑labeled self‑administered (subcutaneous) Cosentyx, plus supporting medical records and/or justification explanation.
For prior targeted immunomodulator use: documentation of drug name, dates of therapy, and duration (claims history or medical records).
For prior methotrexate trial (PsA initial therapy): documentation of 3‑month trial at maximally indicated dose or documentation of contraindication/intolerance.
For prior NSAID trials (AS / nr‑axSpA initial therapy): documentation of two NSAIDs each used for ≥4 weeks at maximally indicated doses or documentation of contraindication/intolerance.
Documentation of initiation and titration per U.S. FDA‑labeled dosing for the relevant indication (PsA, AS, or nr‑axSpA).

Key Coverage Criteria

Intravenous Cosentyx (secukinumab) for administration by a healthcare professional is medically necessary for adult patients with active psoriatic arthritis (PsA) when all applicable criteria below are met.
For initial PsA therapy: diagnosis of active psoriatic arthritis; Cosentyx is initiated and titrated according to U.S. FDA‑labeled dosing for PsA; patient is not receiving Cosentyx in combination with a targeted immunomodulator (examples listed in policy); prescribed by or in consultation with a rheumatologist or dermatologist; initial authorization issued for 12 months.
For initial PsA therapy — additional prerequisites (one of the following must be met): history of failure to a 3‑month trial of methotrexate at the maximally indicated dose unless contraindicated or intolerant; OR prior treatment with a targeted immunomodulator FDA‑approved for PsA (document drug, date, duration).
For PsA continuation of therapy: documentation of positive clinical response; Cosentyx continued per FDA‑labeled dosing for PsA; patient is not receiving Cosentyx in combination with a targeted immunomodulator; authorization issued for 12 months.
Intravenous Cosentyx is medically necessary for adult patients with active ankylosing spondylitis (AS) or non‑radiographic axial spondyloarthritis (nr‑axSpA) when all applicable criteria below are met.
For initial AS / nr‑axSpA therapy: diagnosis of active ankylosing spondylitis or non‑radiographic axial spondyloarthritis; Cosentyx is initiated and titrated according to U.S. FDA‑labeled dosing for AS or nr‑axSpA; patient is not receiving Cosentyx in combination with a targeted immunomodulator (examples listed in policy); prescribed by or in consultation with a rheumatologist; initial authorization issued for 12 months.

20 Active Policies

ARKBLUE-SECUKINUMAB-E-G-COSENTYX-9C67F432D7, Secukinumab (e.g., Cosentyx)

FLORIDA_BLUE-FLBLUE-COSENTYX-IV-CF8E40A027, Cosentyx IV

BCBSLA-00432-06AF1238E9, 00432 secukinumab (Cosentyx)

BCBSM-2049834-7F1742A67D, COSENTYX (SECUKINUMAB)

POINT32HEALTH-PMNG-24526, Cosentyx (secukinumab)

MULTI

MODA-COSENTYX-150DE10D7A, Cosentyx (secukinumab)

IBX-MEDICARE-ADVANTAGE-MA08-174-221236E5B6, Secukinumab (Cosentyx) for Intravenous Use

IBX-COMMERCIAL-08-02-28-59C84D7811, Secukinumab (Cosentyx) for Intravenous Use

BCBSOK-RX501.169, Secukinumab

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

UMR-POL-UMR-cosentyx, Cosentyx (Secukinumab)

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

SUREST-POL-SUREST-cosentyx, Cosentyx (Secukinumab)

AMERIHEALTH-COMMERCIAL-08-02-28-46483A85C8, Secukinumab (Cosentyx) for Intravenous Use

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-174-EEC9AB5595, Secukinumab (Cosentyx) for Intravenous Use

BCBSTN-c538afca30, Secukinumab (Cosentyx)

EVICORE-MEDICAL_DRUG-42E469CA5D41, Cosentyx Intravenous (secukinumab)

UHC-COMM-MD-COSENTYX-SECUKINUMAB-COMMUNITY-PLAN-MEDI-A09EC3C5D5, Cosentyx (Secukinumab) – Community Plan Medical Benefit Drug Policy

UHC-POL-cosentyx, Cosentyx (Secukinumab)

UHC-EXCH-MD-COSENTYX-SECUKINUMAB-INDIVIDUAL-EXCHANGE-612CF582F6, Cosentyx (Secukinumab) – Individual Exchange Medical Benefit Drug Policy

Have a follow-up question?

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

Ask Backwork about J3247 Sign up free

`J3247`, Injection, secukinumab, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J3247`, Injection, secukinumab, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J3247, Injection, secukinumab, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J3247, Injection, secukinumab, intravenous, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J3247`, Injection, secukinumab, intravenous, 1 mg

`J3247`, Injection, secukinumab, intravenous, 1 mg