Does J9053 require prior authorization?

Yes, J9053 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9053?

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

HCPCS/CPT

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Prior authorization requires chart notes or medical record documentation demonstrating failure of previous lines of therapy.
Initial authorization duration is 6 months.

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MULTI

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IBX-MEDICARE-ADVANTAGE-MA08-192A-8642F4CFBD, Belantamab mafodotin-blmf (Blenrep)

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

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

BCBSTN-5fe0c1ad5c, Belantamab Mafodotin-blmf (Blenrep)