Does J3425 require prior authorization?

No, J3425 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J3425?

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

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`J3425`, Injection, hydroxocobalamin, intramuscular, 10 mcg

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

All documentation must be maintained in the patient's medical record and made available to the contractor upon request.
Every page of the medical record must be legible and include appropriate patient identification information (e.g., complete name and dates of service).

Progress notes and laboratory test results indicating present or past serum B12 levels and supporting treatment for the identified diagnosis(es) must be maintained and made available upon request.

Key Coverage Criteria

Vitamin B12 injections are covered only when reasonable and necessary per Local Coverage Determination L33967.
Post-herpetic neuralgia (PHN).
Aetna considers the use of antivirals (oral), gabapentin, intrathecal, interlaminar or transforaminal epidural corticosteroids, lidocaine patch, opioids (oral), pregabalin, and tricyclic anti-depressants medically necessary for post-herpetic neuralgia (PHN).
CPT/HCPCS codes listed in the policy are covered if selection criteria are met (see 'CPT Codes / HCPCS Codes / ICD-10 Codes' section).
ICD-10 codes B02.21 - B02.29 (Zoster [herpes zoster] with other nervous system involvement) are listed as covered diagnoses if selection criteria are met.
Inferred: Postherpetic neuralgia (PHN) — multiple citations focus on treatment and prevention of PHN.

4 Active Policies

FIRST_COAST-L33967, Vitamin B<sub>12</sub> Injections

A57755, Billing and Coding: Vitamin B12 Injections

AETNA-CPB-0725, Post-Herpetic Neuralgia

AETNA-CPB-0406, Tinnitus Treatments

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J3425, Injection, hydroxocobalamin, intramuscular, 10 mcg