Does J9062 require prior authorization?

Yes, J9062 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9062?

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

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`J9062`, Injection, amivantamab 5 mg and hyaluronidase-lpuj

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

Documentation Required

Prior authorization requires test results showing EGFR exon 20 insertion mutations and EGFR exon 19 deletion or exon 21 L858R mutations, where applicable.
Initial prior authorization validity is 6 months (180 days).

Key Coverage Criteria

First-line treatment of adult NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation, in combination with lazertinib, as detected by an FDA-approved test.
Treatment of adult NSCLC with EGFR exon 19 deletion or exon 21 L858R mutation in combination with carboplatin and pemetrexed after progression on or after EGFR TKI.
First-line treatment of adult NSCLC with EGFR exon 20 insertion mutations in combination with carboplatin and pemetrexed, as detected by an FDA-approved test.
Single-agent treatment of adult NSCLC with EGFR exon 20 insertion mutations after progression on or after platinum-based chemotherapy.

9 Active Policies

HEALTHNET_OR-HNOR-AMIVANTAMAB-VMJW-RYBREVANT-AMIVANTAMAB-HYALURONIDASE-LPU-271E25BB11, Amivantamab-vmjw (Rybrevant), Amivantamab/Hyaluronidase-lpuj (Rybrevant Faspro); CP.PHAR.544

MODA-RYBREVANT-FASPRO-CC37A39A42, Rybrevant Faspro (amivantamab and hyaluronidase-lpuj)

IBX-COMMERCIAL-08-01-90D-A842014310, Amivantamab-vmjw (Rybrevant) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro)

IBX-MEDICARE-ADVANTAGE-MA08-148D-F04758DB45, Amivantamab-vmjw (Rybrevant) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro)

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

BCBSTN-47283d87e6, Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro)

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

AMERIHEALTH-COMMERCIAL-08-01-90D-60B1CC6F2E, Amivantamab-vmjw (Rybrevant) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-148D-1611A5D66F, Amivantamab-vmjw (Rybrevant) and Amivantamab and hyaluronidase-lpuj (Rybrevant Faspro)

`J9062`, Injection, amivantamab 5 mg and hyaluronidase-lpuj

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

J9062, Injection, amivantamab 5 mg and hyaluronidase-lpuj

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

9 Active Policies

Related Codes

Have a follow-up question?

`J9062`, Injection, amivantamab 5 mg and hyaluronidase-lpuj