Does J9202 require prior authorization?

Yes, J9202 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9202?

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

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`J9202`, Goserelin acetate implant, per 3.6 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

Medical records for patients receiving a once‑yearly implant must document ongoing follow‑up visits at least every 3 to 4 months and must be provided upon request; lack of requested documentation will result in denial as not medically necessary.
Physician documentation supporting reasonable expectation of survival >12 months is required for coverage of once‑yearly implants for prostate cancer.
Billing frequency should match the drug formulation administered (e.g., bill Vantas 50 mg implant once per 12 months, Eligard 22.5 mg billed per its 3‑month formulation); medical record must support billed frequency when requested.
Laboratory values as applicable (e.g., PSA measurements reported in many trials and used as a secondary outcome).
Imaging/angiographic documentation for PAE (prostatic arterial anatomy identification) and documentation of technical feasibility or reasons for technical failure.
Erectile and ejaculatory function assessment (IIEF-5 or IIEF-15, MSHQ, MSHQ-EjD, SHIM) where preservation of sexual function is a treatment goal.

Key Coverage Criteria

GnRH/LHRH analogs (leuprolide, goserelin, triptorelin, histrelin, leuprolide mesylate/Camcevi) are covered for FDA‑approved indications and for recognized off‑label uses that meet the criteria of LCD L33394.
Leuprolide acetate and histrelin implants administered every 12 months are covered for treatment of prostate cancer when the treating physician reasonably expects the patient to survive at least 12 months.
GnRH analogs are covered when administered at frequencies consistent with the specific product's labeled duration of action (e.g., monthly, every 3, 4, 6, or 12 months).
ICD-10 codes covered if selection criteria are met: N35.010 - N35.92 Urethral stricture
PAE can be considered in patients with hematuria of prostatic origin as a method of achieving cessation of bleeding. (Level of Evidence: D; strength of recommendation: strong)
Alpha adrenergic blockers (alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin)

20 Active Policies

A52453, Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JJ-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JM-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

AETNA-CPB-0079, Benign Prostatic Hyperplasia

AETNA-CPB-0501, Gonadotropin-Releasing Hormone Analogs and Antagonists

BCBSIL-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSMT-RX502.061, Oncology Medications

BCBSNM-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSNM-RX502.061, Oncology Medications

BCBSOK-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSOK-RX502.061, Oncology Medications

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

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

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

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

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

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

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J9202, Goserelin acetate implant, per 3.6 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

Medical records for patients receiving a once‑yearly implant must document ongoing follow‑up visits at least every 3 to 4 months and must be provided upon request; lack of requested documentation will result in denial as not medically necessary.
Physician documentation supporting reasonable expectation of survival >12 months is required for coverage of once‑yearly implants for prostate cancer.
Billing frequency should match the drug formulation administered (e.g., bill Vantas 50 mg implant once per 12 months, Eligard 22.5 mg billed per its 3‑month formulation); medical record must support billed frequency when requested.
Laboratory values as applicable (e.g., PSA measurements reported in many trials and used as a secondary outcome).
Imaging/angiographic documentation for PAE (prostatic arterial anatomy identification) and documentation of technical feasibility or reasons for technical failure.
Erectile and ejaculatory function assessment (IIEF-5 or IIEF-15, MSHQ, MSHQ-EjD, SHIM) where preservation of sexual function is a treatment goal.

Key Coverage Criteria

GnRH/LHRH analogs (leuprolide, goserelin, triptorelin, histrelin, leuprolide mesylate/Camcevi) are covered for FDA‑approved indications and for recognized off‑label uses that meet the criteria of LCD L33394.
Leuprolide acetate and histrelin implants administered every 12 months are covered for treatment of prostate cancer when the treating physician reasonably expects the patient to survive at least 12 months.
GnRH analogs are covered when administered at frequencies consistent with the specific product's labeled duration of action (e.g., monthly, every 3, 4, 6, or 12 months).
ICD-10 codes covered if selection criteria are met: N35.010 - N35.92 Urethral stricture
PAE can be considered in patients with hematuria of prostatic origin as a method of achieving cessation of bleeding. (Level of Evidence: D; strength of recommendation: strong)
Alpha adrenergic blockers (alfuzosin, doxazosin, silodosin, tamsulosin, and terazosin)

20 Active Policies

A52453, Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-J6-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JJ-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

NGS-JK-L33394, Drugs and Biologicals, Coverage of, for Label and Off-Label Uses

PALMETTO-JM-L39387, Luteinizing Hormone-Releasing Hormone (LHRH) Analogs

AETNA-CPB-0079, Benign Prostatic Hyperplasia

AETNA-CPB-0501, Gonadotropin-Releasing Hormone Analogs and Antagonists

BCBSIL-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSMT-RX502.061, Oncology Medications

BCBSNM-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSNM-RX502.061, Oncology Medications

BCBSOK-RX501.041, Gonadotropin-Releasing Hormone (GnRH) Agonists and Antagonists

BCBSOK-RX502.061, Oncology Medications

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

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

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

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

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

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J9202 Sign up free

`J9202`, Goserelin acetate implant, per 3.6 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9202`, Goserelin acetate implant, per 3.6 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9202, Goserelin acetate implant, per 3.6 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9202, Goserelin acetate implant, per 3.6 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9202`, Goserelin acetate implant, per 3.6 mg

`J9202`, Goserelin acetate implant, per 3.6 mg