Does J9248 require prior authorization?

Yes, J9248 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9248?

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

HCPCS/CPT

Prior Auth Required

At least one active policy explicitly requires prior authorization (high confidence)

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Liver-directed administration of high-dose melphalan (Hepzato Kit) is consideredmedically necessarywhenallof the following criteria are met:
18 years of age or older;and
Weight of at least 35 kilograms (77 pounds);and
Metastatic uveal melanoma, whenallthe following criteria are met;Unresectable hepatic liver metastases, confirmed on imaging (computed tomography [CT] or magnetic resonance imaging [MRI]);andLiver metastases affect no more than 50% of the liver;andIf extra-hepatic disease is present, it is:Limited to the bone, lymph nodes, subcutaneous tissues, or lung;andAmenable to either, resection or radiation;and
Unresectable hepatic liver metastases, confirmed on imaging (computed tomography [CT] or magnetic resonance imaging [MRI]);and
Liver metastases affect no more than 50% of the liver;and