Does J3489 require prior authorization?

Yes, J3489 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J3489?

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

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`J3489`, Injection, zoledronic acid, 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

Documentation Required

If bone metastasis (C79.51 or C79.52) is treated, the medical record must also contain the diagnosis of the primary malignant neoplasm and be available on request.
Medical records must include diagnostic information and lab results that support medical necessity, including documentation of specific signs and symptoms substantiating FDA labeled or off‑label use.

The record should indicate the patient was advised to take adequate calcium and vitamin D supplementation.

Diagnosis codes supporting medical necessity must be submitted on the claim, including breast cancer code plus bone loss code and a code documenting current adjuvant SERM or aromatase inhibitor therapy when applicable.

Evidence in the medical record must clearly support the need for IV administration, including description of treatment failure of oral/self‑administered drugs for osteoporosis and for heterotopic ossification when applicable.

Serum creatinine must be measured prior to administration and documented in the medical record.

Key Coverage Criteria

Intravenous bisphosphonate administration is covered for treatment of osteoporosis when medical record documents need for IV route, including description of treatment failure of oral or self‑administered osteoporosis drugs.
Bisphosphonate therapy is covered for heterotopic ossification when the medical record documents clinical need for treatment and justifies IV administration.
Bisphosphonate therapy is covered for bone metastasis (C79.51 or C79.52) provided the patient's record also contains a diagnosis of the primary malignant neoplasm.
In breast cancer patients receiving adjuvant selective estrogen receptor modulators or aromatase inhibitor therapy, bisphosphonates are covered when billed with an appropriate breast cancer diagnosis code and a bone loss diagnosis code documenting treatment indication.
“When bilateral core decompression is indicated, it can be done simultaneously on both hips...”
Aetna considers core decompression medically necessary for the treatment of early/pre-collapse (stage I or II; before X-ray changes are evident) avascular necrosis of the hip (femoral head and/or neck).

11 Active Policies

FLORIDA_BLUE-FLBLUE-ZOMETA-ZOLEDRONIC-ACID-CE18785BF2, Zometa (zoledronic acid)

A56907, Billing and Coding: Bisphosphonate Drug Therapy

WPS-J5-L34648, Bisphosphonate Drug Therapy

WPS-J8-L34648, Bisphosphonate Drug Therapy

BCBSLA-00191-C5394700C5, 00191 zoledronic acid (Zometa, Reclast)-Retired policy

HEALTHNET_OR-HNOR-ZOLEDRONIC-ACID-RECLAST-CP-PHAR-59-5396741564, Zoledronic Acid (Reclast); CP.PHAR.59

AETNA-CPB-0753, Core Decompression for Avascular Necrosis

BCBSTN-644f7a37c5, Zoledronic Acid (Reclast)

BCBSTN-dd1a89ad07, Zoledronic Acid (Zometa)

EVICORE-MEDICAL_DRUG-DD82A0F6E697, Reclast (zoledronic acid) Non-oncology

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

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J3489, Injection, zoledronic acid, 1 mg