Does J3358 require prior authorization?

Yes, J3358 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J3358?

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

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`J3358`, Ustekinumab, for intravenous injection, 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

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.
Ustekinumab prior authorization initial validity is 6 months unless otherwise specified.
MedicalNecessity: For axial or severe Enthesitis PsA, require documented inadequate response to two 1-month NSAID trials or NSAID with steroid injection, AND inadequate response or intolerance to at least a 3-month trial of adalimumab-fkjp/Hadlima or continuation of prior treatment.
For Stelara, prior inadequate response, contraindication, or intolerance to ALL ustekinumab biosimilar products is required before coverage (i.e., failure or contraindication/intolerance to all biosimilars).

20 Active Policies

ARKBLUE-MEASUREMENT-OF-SERUM-ANTIBODIES-TO-INFLIXIMAB-AD-67B2805EB5, Measurement of Serum Antibodies to Infliximab, Adalimumab, Vedolizumab, and Ustekinumab

ARKBLUE-USTEKINUMAB-E-G-STELARA-AND-BIOSIMILARS-2ED89044EC, Ustekinumab (e.g., Stelara) and Biosimilars

FLORIDA_BLUE-FLBLUE-USTEKINUMAB-STELARA-6D0609DA34, Ustekinumab (Stelara)

BCIDAHO-05-01-664-0263ECEDB1, Intravenous Ustekinumab for Inflammatory Bowel Disease. Medical Policy MP 5.01.664 Intravenous Ustekinumab for Inflammatory Bowel Disease DISCLAIMER/INSTRUCTIONS FOR USE This medical policy

BCBSLA-00242-1E0C13813D, 00242 ustekinumab Products

BCBSM-2078291-0D8D11DB07, USTEKINUMAB PRODUCTS

POINT32HEALTH-PMNG-24626, Ustekinumab Subcutaneous Products

MULTI

POINT32HEALTH-PMNG-23201, Yesintek (ustekinumab-kfce) and Starjemza (ustekinumab-hmny) Subcutaneous

MULTI

BCBSND-USTEKINUMAB-STELARA-IV-3EC860EB80, Ustekinumab Stelara IV

BCBSND-USTEKINUMAB-STELARA-IV-ME-DA506E6696, Ustekinumab Stelara IV ME

BCBSNJ-PATHOLOGY-076-038B06E34C, Measurement of Serum Antibodies to Infliximab, Adalimumab, Ustekinumab and Vedolizumab

BCBSNJ-DRUGS-071-7E6AD401BE, Ustekinumab (Stelara)

MODA-USTEKINUMAB-622B4DD5F0, Ustekinumab: Stelara; Wezlana; Selarsdi; Pyzchiva; Otulfi; Imuldosa; Yesintek; Steqeyma; Starjemza; Ustekinumab-aekn§; Ustekinumab-ttwe§; Ustekinumab-aauz§; Ustekinumab-stba§; Ustekinumab§

IBX-COMMERCIAL-08-00-82Q-8D6B82A514, Ustekinumab for Intravenous Infusion

IBX-MEDICARE-ADVANTAGE-MA08-042L-1DAE799D1E, Ustekinumab for Intravenous Use

BCBSTN-d766e3ac4b, Ustekinumab Products: Ustekinumab (Stelara); Ustekinumab-auub (Wezlana); Ustekinumab-srlf (Imuldosa); Ustekinumab-aauz (Otulfi); Ustenkinumab-ttwe (Pyzchiva), Ustekinumab-aekn (Selarsdi); Ustenkinumab-stba (Steqeyma); Ustenkinumba-kfce (Yesintek); ustekinumab; ustekinumab-aauz, ustekinumab-stba, ustekinumab-aekn ; ustenkinumab-ttwe; Ustekinumab-hmny (Starjemza)

BCBSTX-RX501.114, Ustekinumab and Associated Biosimilars

EVICORE-MEDICAL_DRUG-77DEBEA86A94, Ustekinumab Intravenous (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Starjemza, Steqeyma, Wezlana, Yesintek, ustekinumab, ustekinumab-ttwe)

UHC-COMM-MD-USTEKINUMAB-COMMUNITY-PLAN-MEDICAL-BENEF-86C6E58C78, Ustekinumab – Community Plan Medical Benefit Drug Policy

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

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J3358, Ustekinumab, for intravenous injection, 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

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.
Ustekinumab prior authorization initial validity is 6 months unless otherwise specified.
MedicalNecessity: For axial or severe Enthesitis PsA, require documented inadequate response to two 1-month NSAID trials or NSAID with steroid injection, AND inadequate response or intolerance to at least a 3-month trial of adalimumab-fkjp/Hadlima or continuation of prior treatment.
For Stelara, prior inadequate response, contraindication, or intolerance to ALL ustekinumab biosimilar products is required before coverage (i.e., failure or contraindication/intolerance to all biosimilars).

20 Active Policies

ARKBLUE-MEASUREMENT-OF-SERUM-ANTIBODIES-TO-INFLIXIMAB-AD-67B2805EB5, Measurement of Serum Antibodies to Infliximab, Adalimumab, Vedolizumab, and Ustekinumab

ARKBLUE-USTEKINUMAB-E-G-STELARA-AND-BIOSIMILARS-2ED89044EC, Ustekinumab (e.g., Stelara) and Biosimilars

FLORIDA_BLUE-FLBLUE-USTEKINUMAB-STELARA-6D0609DA34, Ustekinumab (Stelara)

BCBSLA-00242-1E0C13813D, 00242 ustekinumab Products

BCBSM-2078291-0D8D11DB07, USTEKINUMAB PRODUCTS

POINT32HEALTH-PMNG-24626, Ustekinumab Subcutaneous Products

MULTI

POINT32HEALTH-PMNG-23201, Yesintek (ustekinumab-kfce) and Starjemza (ustekinumab-hmny) Subcutaneous

MULTI

BCBSND-USTEKINUMAB-STELARA-IV-3EC860EB80, Ustekinumab Stelara IV

BCBSND-USTEKINUMAB-STELARA-IV-ME-DA506E6696, Ustekinumab Stelara IV ME

BCBSNJ-PATHOLOGY-076-038B06E34C, Measurement of Serum Antibodies to Infliximab, Adalimumab, Ustekinumab and Vedolizumab

BCBSNJ-DRUGS-071-7E6AD401BE, Ustekinumab (Stelara)

IBX-COMMERCIAL-08-00-82Q-8D6B82A514, Ustekinumab for Intravenous Infusion

IBX-MEDICARE-ADVANTAGE-MA08-042L-1DAE799D1E, Ustekinumab for Intravenous Use

BCBSTX-RX501.114, Ustekinumab and Associated Biosimilars

EVICORE-MEDICAL_DRUG-77DEBEA86A94, Ustekinumab Intravenous (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Starjemza, Steqeyma, Wezlana, Yesintek, ustekinumab, ustekinumab-ttwe)

UHC-COMM-MD-USTEKINUMAB-COMMUNITY-PLAN-MEDICAL-BENEF-86C6E58C78, Ustekinumab – Community Plan Medical Benefit Drug Policy

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

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

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`J3358`, Ustekinumab, for intravenous injection, 1 mg

Prior Authorization

Medicare Pricing

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J3358`, Ustekinumab, for intravenous injection, 1 mg

Prior Authorization

Medicare Pricing

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J3358, Ustekinumab, for intravenous injection, 1 mg

Prior Authorization

Medicare Pricing

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J3358, Ustekinumab, for intravenous injection, 1 mg

Prior Authorization

Medicare Pricing

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J3358`, Ustekinumab, for intravenous injection, 1 mg

`J3358`, Ustekinumab, for intravenous injection, 1 mg