Does J9030 require prior authorization?

Yes, J9030 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9030?

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

HCPCS/CPT

Prior Auth Required

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

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Medical record must document the actual number of milligrams of BCG instilled per treatment to support the number of J9030 units billed.
Record the clinical indication (e.g., bladder cancer) and any justification for administering less than the FDA label dose (shortage-related) in the patient record.

Use HCPCS code J9030 (BCG live intravesical instillation, 1 mg) to report intravesical BCG treatments effective 2019-07-01.
When actual instilled dose is less than the FDA label dose (81 mg / 1 vial) because of BCG shortage, report the actual reduced dose using J9030 with units equal to milligrams instilled.

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

A56754, Billing and Coding: Intravesical Instillation of Bacillus Calmette-Guérin (BCG)

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