Does J3387 require prior authorization?

No, J3387 does not require prior authorization (high confidence). Code is covered without prior authorization.

What is the Medicare reimbursement rate for J3387?

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

HCPCS/CPT

No Prior Auth Required

Code is covered without prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

A one-time infusion of elivaldogene autotemcel is consideredmedically necessarywhenallof the following criteria are met:
The individual is in the early stages of cerebral adrenoleukodystrophy (CALD), as confirmed by the following:Elevated very long chain fatty acid levels;andConfirmation of the presence of anABCD1genetic mutation;andCALD-specific Neurological Function Scale (NFS) score of 0 or 1;andActive central nervous system (CNS) disease with demyelinating lesions demonstrated on brain gadolinium-enhanced MRI with Loes score between 0.5 and 9.0 on the 34-point scale;and
Elevated very long chain fatty acid levels;and
Confirmation of the presence of anABCD1genetic mutation;and
CALD-specific Neurological Function Scale (NFS) score of 0 or 1;and
Active central nervous system (CNS) disease with demyelinating lesions demonstrated on brain gadolinium-enhanced MRI with Loes score between 0.5 and 9.0 on the 34-point scale;and