Does J8999 require prior authorization?

Yes, J8999 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J8999?

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

Backwork Sign up free

`J8999`, Prescription drug, oral, chemotherapeutic, nos

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 prior to claim submission for items requiring an SWO.
For DMEPOS base items requiring a Written Order Prior to Delivery (WOPD), the supplier must have a signed WOPD listing the base item (and may list associated options/accessories) prior to delivery.

For refills, suppliers must contact the beneficiary and document an affirmative response prior to dispensing the refill and document the refill request; contact must occur no sooner than 30 days prior to expected end of current supply.

Claims and documentation must also meet the LCD-related Standard Documentation Requirements Article, the LCD-related Policy Article, and Supplier Manual requirements as applicable.

Key Coverage Criteria

Oral anticancer drugs are covered when they are eligible for a defined Medicare benefit category, are reasonable and necessary for diagnosis or treatment (or to improve functioning of a malformed body member), and meet all applicable Medicare statutory and regulatory requirements.
Coverage requires that the statutory coverage criteria for oral anticancer drugs, as specified in the related LCD Policy Article, are met and the drug must be reasonable and necessary for the individual beneficiary.
Oral anticancer and oral antiemetic drugs are covered only if dispensed and billed to Medicare by the entity that actually dispenses the drug to the beneficiary and that entity is permitted under applicable federal, state, and local laws to dispense drugs.

2 Active Policies

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

L33826, Oral Anticancer Drugs

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J8999 Sign up free

J8999, Prescription drug, oral, chemotherapeutic, nos