Does J3315 require prior authorization?

Yes, J3315 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J3315?

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

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`J3315`, Injection, triptorelin pamoate, 3.75 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

Medical records for patients receiving a once‑yearly implant must document ongoing follow‑up visits at least every 3 to 4 months and must be provided upon request; lack of requested documentation will result in denial as not medically necessary.

Billing frequency should match the drug formulation administered (e.g., bill Vantas 50 mg implant once per 12 months, Eligard 22.5 mg billed per its 3‑month formulation); medical record must support billed frequency when requested.

When submitting claims with discarded Part B drugs/biologicals from single-use vials or packages, document the discarded amount and reason in the patient’s medical record.

Key Coverage Criteria

GnRH/LHRH analogs (leuprolide, goserelin, triptorelin, histrelin, leuprolide mesylate/Camcevi) are covered for FDA‑approved indications and for recognized off‑label uses that meet the criteria of LCD L33394.
Leuprolide acetate and histrelin implants administered every 12 months are covered for treatment of prostate cancer when the treating physician reasonably expects the patient to survive at least 12 months.
GnRH analogs are covered when administered at frequencies consistent with the specific product's labeled duration of action (e.g., monthly, every 3, 4, 6, or 12 months).
Administration of LHRH analogs is covered when prescribed, dosed, and administered consistent with FDA-approved labeling.
Administration code 96402 may be billed with HCPCS codes J1950, J9217, J9202, J3315, J1952, and J1954.
Administration codes 11981, 11982, and 11983 may be billed with HCPCS codes J9219 and J9225.

19 Active Policies

ARKBLUE-TRIPTORELIN-E-G-TRIPTODUR-TRELSTAR-376B193413, Triptorelin (e.g., Triptodur, Trelstar)

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

A52453, Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

PALMETTO-JJ-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JM-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

HEALTHNET_OR-HNOR-TRIPTORELIN-PAMOATE-TRELSTAR-TRIPTODUR-CP-PHAR-175-B798D33615, Triptorelin pamoate (Trelstar, Triptodur); CP.PHAR.175

BCBSNM-RX502.061, Oncology Medications

BCBSOK-RX502.061, Oncology Medications

UMR-POL-UMR-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

SUREST-POL-SUREST-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

BCBSTN-e8b7c3cddf, Triptorelin Pamoate (Trelstar)

AETNA-CPB-0079, Benign Prostatic Hyperplasia

EVICORE-HPLAN-HEALTH_PARTNERS_PLANS-4BC80209CCC5, Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List

A59160, Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

UHC-POL-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

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

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

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J3315, Injection, triptorelin pamoate, 3.75 mg