Does J9056 require prior authorization?

Yes, J9056 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9056?

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

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`J9056`, Injection, bendamustine hydrochloride (vivimusta), 1 mg

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

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.

5 Active Policies

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

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

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

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J9056, Injection, bendamustine hydrochloride (vivimusta), 1 mg