Does J9228 require prior authorization?

Yes, J9228 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9228?

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

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`J9228`, Injection, ipilimumab, 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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.
Coverage determinations must include review of the member's benefit contract or SPD for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).

Key Coverage Criteria

Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Ipilimumab plus nivolumab with platinum-doublet chemo for first-line NSCLC without EGFR/ALK alterations.

20 Active Policies

ARKBLUE-IPILIMUMAB-E-G-YERVOY-2433867C34, Ipilimumab (e.g., Yervoy)

FLORIDA_BLUE-FLBLUE-IPILIMUMAB-YERVOY-7EB3E827DD, Ipilimumab (Yervoy)

BCBSM-2070004-7CC2DA1E2C, YERVOY (IPILIMUMAB)

HEALTHPARTNERS-CC-AENTRY-046023, Oncology - ipilimumab (Yervoy)

MULTI

BCBSND-IPILIMUMAB-YERVOY-98B913A1BF, Ipilimumab Yervoy

BCBSNE-X-104-5325982199, YERVOY (PREAUTHORIZATION REQUIRED)

BCBSNJ-DRUGS-089-3FAB84A473, Ipilimumab (Yervoy)

MODA-YERVOY-9D795749B2, Yervoy (ipilimumab)

HEALTHNET_OR-HNOR-IPILIMUMAB-YERVOY-CP-PHAR-319-B803821C6B, Ipilimumab (Yervoy); CP.PHAR.319

IBX-MEDICARE-ADVANTAGE-MA08-059L-FDE2E7E2C3, Ipilimumab (Yervoy)

IBX-COMMERCIAL-08-01-01O-7D53E7785C, Ipilimumab (Yervoy)

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

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

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

AMERIHEALTH-COMMERCIAL-08-01-01O-8EE278E5A7, Ipilimumab (Yervoy)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-059L-58E9C52E62, Ipilimumab (Yervoy)

BCBSTN-a9777d8c12, Ipilimumab (Yervoy)

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

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

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J9228, Injection, ipilimumab, 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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.
Coverage determinations must include review of the member's benefit contract or SPD for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).

Key Coverage Criteria

Coverage of injectable oncology medications is based on NCCN Compendium Categories of Evidence and Consensus (1, 2A, 2B = proven/medically necessary; 3 = unproven/not medically necessary); if NCCN is unavailable, base decisions on FDA labeling.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Ipilimumab plus nivolumab with platinum-doublet chemo for first-line NSCLC without EGFR/ALK alterations.

20 Active Policies

ARKBLUE-IPILIMUMAB-E-G-YERVOY-2433867C34, Ipilimumab (e.g., Yervoy)

FLORIDA_BLUE-FLBLUE-IPILIMUMAB-YERVOY-7EB3E827DD, Ipilimumab (Yervoy)

BCBSM-2070004-7CC2DA1E2C, YERVOY (IPILIMUMAB)

HEALTHPARTNERS-CC-AENTRY-046023, Oncology - ipilimumab (Yervoy)

MULTI

BCBSND-IPILIMUMAB-YERVOY-98B913A1BF, Ipilimumab Yervoy

BCBSNE-X-104-5325982199, YERVOY (PREAUTHORIZATION REQUIRED)

BCBSNJ-DRUGS-089-3FAB84A473, Ipilimumab (Yervoy)

MODA-YERVOY-9D795749B2, Yervoy (ipilimumab)

HEALTHNET_OR-HNOR-IPILIMUMAB-YERVOY-CP-PHAR-319-B803821C6B, Ipilimumab (Yervoy); CP.PHAR.319

IBX-MEDICARE-ADVANTAGE-MA08-059L-FDE2E7E2C3, Ipilimumab (Yervoy)

IBX-COMMERCIAL-08-01-01O-7D53E7785C, Ipilimumab (Yervoy)

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

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

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

AMERIHEALTH-COMMERCIAL-08-01-01O-8EE278E5A7, Ipilimumab (Yervoy)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-059L-58E9C52E62, Ipilimumab (Yervoy)

BCBSTN-a9777d8c12, Ipilimumab (Yervoy)

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

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

Have a follow-up question?

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

Ask Backwork about J9228 Sign up free

`J9228`, Injection, ipilimumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9228`, Injection, ipilimumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9228, Injection, ipilimumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9228, Injection, ipilimumab, 1 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9228`, Injection, ipilimumab, 1 mg

`J9228`, Injection, ipilimumab, 1 mg