Does J9036 require prior authorization?

Yes, J9036 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9036?

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

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`J9036`, Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 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

Key Coverage Criteria

Covered indication: FDA-approved indications and compendial uses are covered when all approval criteria are met and the member has no exclusions to the prescribed therapy.

7 Active Policies

BCBSND-BENBENDAMUSTINE-TREANDA-BENDEKA-BELRAPZO-EA5ACE1D00, Benbendamustine Treanda Bendeka Belrapzo

BCBSNJ-DRUGS-116-EFD9F530EC, Bendamustine Hydrochloride (Treanda, Bendeka, Belrapzo)

HEALTHNET_OR-HNOR-BENDAMUSTINE-BELRAPZO-BENDEKA-TREANDA-VIVIMUSTA-CP-PHAR-42D703039B, Bendamustine (Belrapzo, Bendeka, Treanda, Vivimusta); CP.PHAR.307

MODA-BENDAMUSTINE-25AE90065B, Bendamustine: Treanda; Bendeka; Belrapzo; Vivimusta; Bendamustine Ψ

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

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

BCBSTN-a2af96ec42, Bendamustine Products (Treanda, Belrapzo, Bendeka, Vivimusta, Bendamustine)

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J9036, Injection, bendamustine hydrochloride, (belrapzo/bendamustine), 1 mg