Does J9155 require prior authorization?

Yes, J9155 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9155?

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

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`J9155`, Injection, degarelix, 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

Documentation Required

Central Precocious Puberty (initial): Documentation of diagnosis of central precocious puberty (idiopathic or neurogenic); documentation of onset of secondary sexual characteristics by age (females 64; 8 yrs; males 64; 9 yrs); confirmation of diagnosis by one of the following: pubertal basal LH (based on lab reference ranges), a pubertal LH response to a GnRH stimulation test, or bone age advanced one year beyond chronological age.

Endometriosis (initial): Documentation of diagnosis or suspected endometriosis; documentation of contraindication/intolerance/failure of BOTH oral contraceptives or depot medroxyprogesterone AND NSAIDs, OR documentation patient had surgical ablation to prevent recurrence; plan stating intended course (initial course limited to 6 months).

Fertility Preservation: Documentation that patient is pre-menopausal and receiving a cytotoxic agent associated with causing primary ovarian insufficiency (examples listed in policy); documentation of start and expected duration of cytotoxic therapy; documentation that GnRH therapy will be discontinued upon completion of cytotoxic treatment.

Key Coverage Criteria

Central Precocious Puberty (Fensolvi, Lupron Depot-Ped, Supprelin LA, Triptodur): treatment of central precocious puberty (idiopathic or neurogenic) when criteria are met (see diagnosis/age/confirmation requirements).
Endometriosis (Lupron Depot, Zoladex): treatment of endometriosis or suspected endometriosis when criteria are met (see prior therapy or surgical ablation requirements).
Endometrial Thinning/Dysfunctional Uterine Bleeding (Zoladex): endometrial thinning prior to endometrial ablation when criteria are met.
Fertility Preservation: use of GnRH analogs for fertility preservation in pre-menopausal women receiving a cytotoxic agent associated with causing primary ovarian insufficiency.
Uterine Leiomyomata (Fibroids) (Lupron Depot): preoperative hematologic improvement for leiomyomata-related anemia unresponsive to iron therapy and/or preoperative size reduction to facilitate surgical procedure.
Gender Dysphoria in Adolescents: GnRH analogs may be covered for treatment of gender dysphoria in adolescents when comprehensive diagnostic, prescriber, laboratory, psychosocial support, and documentation criteria are met.

13 Active Policies

BCBSNJ-DRUGS-069-0A38791BE5, Gonadotropin-Releasing Hormone (GnRH) Receptor Antagonist [Degarelix (Firmagon)]

HEALTHNET_OR-HNOR-DEGARELIX-ACETATE-FIRMAGON-CP-PHAR-170-BD06E2A0BB, Degarelix Acetate (Firmagon); CP.PHAR.170

BCBSTN-60cf2c2a29, Degarelix (Firmagon)

UHC-POL-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

AETNA-CPB-0079, Benign Prostatic Hyperplasia

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

BCBSNM-RX502.061, Oncology Medications

BCBSOK-RX502.061, Oncology Medications

UMR-POL-UMR-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

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

SUREST-POL-SUREST-gonadotropin-releasing-hormone-analogs, Gonadotropin Releasing Hormone Analogs

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

`J9155`, Injection, degarelix, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

J9155, Injection, degarelix, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`J9155`, Injection, degarelix, 1 mg