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HCPCS/CPT J9054, Injection, bortezomib (boruzu), 0.1 mg | Prior Auth Required

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`J9054`, Injection, bortezomib (boruzu), 0.1 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

Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
Authorization of 12 months may be granted for the treatment of systemic light chain amyloidosis.
Authorization of 12 months may be granted for the treatment of relapsed or refractory follicular lymphoma.
Authorization of 12 months may be granted for the treatment of Kaposi sarcoma as subsequent therapy.
Authorization of 12 months may be granted for the treatment of relapsed or refractory Pediatric Classic Hodgkin Lymphoma.
Authorization of 12 months may be granted for treatment of POEMS syndrome in combination with dexamethasone.

8 Active Policies

MODA-VELCADE-38FD53BFF7, Bortezomib Velcade; Boruzu; Bortezomib§

OR

HEALTHNET_OR-HNOR-BORTEZOMIB-BORUZU-VELCADE-CP-PHAR-410-67DA92F6E0, Bortezomib (Boruzu, Velcade); CP.PHAR.410

OR

BCBSTN-7839defca4, Bortezomib (Velcade; Bortezomib, Boruzu)

UHC-POL-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

UMR-POL-UMR-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

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

SUREST-POL-SUREST-oncology-medication-clinical-coverage-policy, Oncology Medication Clinical Coverage

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

Related Codes

J9041(8 policies)J9049(8 policies)J1954(5 policies)J0897(5 policies)J0641(5 policies)J1950(5 policies)J0642(5 policies)J1323(5 policies)

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