Does J8655 require prior authorization?

Yes, J8655 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J8655?

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

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`J8655`, Netupitant 300 mg and palonosetron 0.5 mg, oral

HCPCS/CPT

Prior Authorization

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted; lack of a completed SWO will result in denial.
For DMEPOS base items requiring WOPD, the supplier must have a signed WOPD prior to delivery; WOPD must list the base item and may list separately billed associated options/accessories/supplies.

Key Coverage Criteria

Coverage requires that the item meet Medicare statutory criteria (eligible benefit category and be reasonable and necessary) per Social Security Act §1862(a)(1)(A).
An FDA‑approved oral 3‑drug antiemetic regimen consisting of an oral NK‑1 antagonist plus an oral 5‑HT3 antagonist and dexamethasone (HCPCS J8540) is covered when administered to beneficiaries receiving one or more of the following chemotherapeutic agents: Alemtuzumab, Azacitidine, Bendamustine, Carboplatin, Carmustine, Cisplatin, Clofarabine, Cyclophosphamide, Cytarabine, Dacarbazine, Daunorubicin, Doxorubicin, Epirubicin, Idarubicin, Ifosfamide, Irinotecan, Lomustine, Mechlorethamine, Oxalipla [...]
Prevention of chemotherapy-induced nausea and vomiting (CINV) due to High Emetic Risk parenteral anticancer agents when an NK1 RA (e.g., Emend, Cinvanti, Varubi) is used in combination with a 5HT3 RA.
Prevention of CINV due to Moderate Emetic Risk parenteral anticancer agents when an NK1 RA is used in combination with a 5HT3 RA and the patient has one or more CINV risk factors (younger age <55 years; female sex; previous history of chemotherapy-induced nausea/vomiting; little or no previous alcohol use; history of motion sickness or morning sickness during pregnancy; high anxiety).
Prevention of CINV due to High Emetic Risk parenteral anticancer agents when a 5HT3 RA (Aloxi, Kytril, Sustol, Zofran) is used in combination with an NK1 RA.
Prevention of CINV due to Moderate Emetic Risk parenteral anticancer agents when a 5HT3 RA is used (standalone option for moderate risk).

11 Active Policies

BCBSM-2099264-5FE36B7570, FOSNETUPITANT PALONOSETRON INJECTION: AKYNZEO (C9033) RETIRED AS OF 10/8/2020

BCBSMS-L-5-01-531-AFD3857255, Akynzeo (netupitant and palonosetron)

POINT32HEALTH-PMNG-14551, Akynzeo (netupitant/palonosetron)

MULTI

BCBSNJ-DRUGS-072-283AA8103D, Injectable Antiemetic Agents [Dolasetron (Anzemet), Granisetron (Kytril, Sustol), Ondansetron (Zofran), Palonosetron (Aloxi), Rolapitant (Varubi), Aprepitant (Cinvanti), Fosaprepitant (Emend), and Fosnetupitant/Palonosetron (Akynzeo), Amisulpride (Barhemsys)]

HEALTHNET_OR-HNOR-NETUPITANT-AND-PALONOSETRON-AKYNZEO-FOSNETUPITANT-AND-PA-089C904F43, Netupitant and Palonosetron (Akynzeo), Fosnetupitant and Palonosetron (Akynzeo IV); CP.PMN.158

MODA-AKYNZEO-A2ECE282CE, Akynzeo (fosnetupitant/palonosetron)

UHC-POL-antiemetics-oncology, Antiemetics for Oncology

L33827, Oral Antiemetic Drugs (Replacement for Intravenous Antiemetics)

UMR-POL-UMR-antiemetics-oncology, Antiemetics for Oncology

SUREST-POL-SUREST-antiemetics-oncology, Antiemetics for Oncology

EVICORE-HPLAN-CIGNA-729A536F50C8, Q3 - 2026 Cigna MedOnc Master Drug List.pdf

`J8655`, Netupitant 300 mg and palonosetron 0.5 mg, oral

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

J8655, Netupitant 300 mg and palonosetron 0.5 mg, oral

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`J8655`, Netupitant 300 mg and palonosetron 0.5 mg, oral