Does J9215 require prior authorization?

No, J9215 does not require prior authorization (high confidence). Covered without prior authorization.

What is the Medicare reimbursement rate for J9215?

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

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`J9215`, Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu

HCPCS/CPT

Prior Authorization

No Prior Auth Required

Covered without prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Claims must be supported by medical record documentation of the patient’s diagnosis/clinical condition and justification that the selected drug, dose, and route of administration are appropriate and medically necessary for the non-oncologic indication.
Billing must comply with Medicare rules and any applicable LCD prior authorization or documentation requirements; follow any specific forms or prior authorization processes required by the LCD or payer.

Documentation that the keloid scar is painful, ulcerated, or pruritic and that it causes a functional impairment (example given: restricted movement) is required for coverage of keloid-specific procedures (explicitly stated in bracketed clarification for CPT 17110/17111).

Records of prior conservative therapies and duration of those treatments when applicable (e.g., for consideration of laser therapy: documentation that scars were persistent for more than 1 month despite silicone gel/sheeting, hypoallergenic tape, or onion extract; and for widespread hypertrophic burn scars, failure of silicone gel/sheeting, pressure garments, and/or onion extract for 8–12 weeks — per UpToDate Hultman and Yoshida, 2021).

Key Coverage Criteria

Anti-neoplastic (chemotherapy) agent CPT/HCPCS codes may be used to bill for administration of these drugs when given to treat non-oncologic (noncancer) diagnoses if the drug is medically necessary for the patient’s condition and consistent with the standard of medical practice.
Monoclonal antibody agents and other biologic response modifiers may be administered and billed using chemotherapy administration codes for noncancer indications when the dose, route, and clinical use are appropriate and medically necessary.
Treatment of traumatic or surgical scars with non-ablative fractional laser (NAFL, 1,500-nm) or ablative fractional laser (AFL, 10,600-nm) — Chitgopeker et al, 2020 (split-scar study in 100 patients)
Ablative fractional lasers (CO2 10,600-nm and Er:YAG 2,940-nm) to improve erythema, height, and pliability of hypertrophic and keloid scars — Oosterhoff et al, 2021 systematic review
1,470-nm diode laser with an intralesional optical fiber device for treatment of inflamed keloid scars accompanying serious local infection and fester — Li et al, 2019
Micro-plasma radiofrequency (MPR) combined with hypo-fractionated electron-beam radiation (EBR) for treatment of multiple/widely distributed keloids — Zhang et al, 2019 (case series)

5 Active Policies

WPS-J5-L37205, Chemotherapy Drugs and their Adjuncts

A55639, Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions

WPS-J8-L37205, Chemotherapy Drugs and their Adjuncts

AETNA-CPB-0389, Hypertrophic Scars and Keloids

AETNA-CPB-0759, Vulvodynia and Vulvar Vestibulitis Treatments

`J9215`, Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

J9215, Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

5 Active Policies

Related Codes

Have a follow-up question?

`J9215`, Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu