Does J3402 require prior authorization?

Yes, J3402 requires prior authorization (medium confidence). Conditional coverage; review criteria to confirm PA need.

What is the Medicare reimbursement rate for J3402?

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

Backwork Sign up free

`J3402`, Injection, remestemcel-l-rknd, per therapeutic dose

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

Inferred documentation items that would support medical necessity: documentation that the patient's own stem cells have been destroyed by disease or by intensive treatment (e.g., records of high‑dose chemotherapy and/or radiation); documentation of donor identity (related or unrelated) and donor selection; records of the infusion procedure and subsequent engraftment (e.g., blood counts, marrow reports); documentation of immunosuppressive therapy given prior to transplantation.

Key Coverage Criteria

Individual is 2 months to 17 years of age ${ }^{5,11}$; AND
Recurrence of GVHD after CR — Repeat administration of Ryoncil twice a week for an additional 4
Transplantation of stem cells from healthy donors to an individual whose own stem cells have been destroyed by disease.
Transplantation of stem cells from healthy donors to an individual whose own stem cells have been destroyed by intensive treatments (e.g., high-dose chemotherapy and/or radiation therapy).
Use of donor stem cells from either a related or unrelated donor for engraftment (produced blood cells) following infusion into the recipient's bloodstream.
Treatment for acute graft-versus-host disease (aGVHD) — treatment decisions are based on the specific organs involved, the severity (or grade) of the disease and whether the GI tract is affected.

13 Active Policies

ARKBLUE-REMESTEMCEL-L-RKND-E-G-RYONCIL-43E2C2ED2A, Remestemcel-L-rknd (e.g., Ryoncil)

FLORIDA_BLUE-FLBLUE-RYONCIL-REMESTEMCEL-L-RKND-93627B2C70, Ryoncil (remestemcel-L-rknd)

BCIDAHO-05-01-674-E654A87AEA, Ryoncil (remestemcel-L). Medical Policy MP 5.01.674 Ryoncil (remestemcel-L) DISCLAIMER/INSTRUCTIONS FOR USE This medical policy provides general guidance for applying Blue Cross of Idaho benefit

BCBSLA-00933-226A3F2E01, 00933 remestemcl-L-rknd (Ryoncil)

BCBSM-2193631-EE61C52DA1, RYONCIL (REMESTEMCEL-L)

BCBSMS-S-5-01-629-8BCFE7A087, State and School Employees' Health Insurance Plan - Ryoncil (remestemcel-L-rknd)

BCBSMS-L-5-01-629-9A9B79C633, Ryoncil (remestemcel-L-rknd)

POINT32HEALTH-MDMNG-25066, Ryoncil (remestemcel-L)

MULTI

HEALTHPARTNERS-CC-ENTRY-286215, Remestemcel-L-rknd (Ryoncil)

MULTI

MODA-RYONCIL-14DC7DA8AF, Ryoncil (remestemcel-L-rknd)

HEALTHNET_OR-HNOR-REMESTEMCEL-L-RKND-RYONCIL-CP-PHAR-474-0D2553F508, Remestemcel-L-rknd (Ryoncil); CP.PHAR.474

BCBSTN-5d0278470d, Remestemcel-L-rknd (Ryoncil)

HUMANA-RYONCIL-REMESTEMCEL-L-RKND-MA, Ryoncil (remestemcel-L-rknd)

J3402, Injection, remestemcel-l-rknd, per therapeutic dose