Does J9263 require prior authorization?

Yes, J9263 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9263?

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

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`J9263`, Injection, oxaliplatin, 0.5 mg

HCPCS/CPT

Prior Authorization

Prior Auth Required

Code explicitly requires prior authorization (high confidence)

Medicare Pricing

Work RVU

0.00

Facility

N/A

Non-Facility

N/A

Documentation Required

Clinical documentation confirming the specific diagnosis that matches one of the covered indications (e.g., pathology report, imaging, oncology consult).
For adjuvant stage III colon cancer: documentation of complete resection of the primary tumor (operative and pathology reports) and staging consistent with stage III disease.

For continuation of therapy: documentation demonstrating no disease progression and no unacceptable toxicity while on the current oxaliplatin regimen (treatment notes, imaging reports, toxicity assessments).

Treatment plan including oxaliplatin dosing, schedule/regimen (e.g., FOLFOX dosing: oxaliplatin 85 mg/m2 IV over 120 minutes with leucovorin and 5-FU per label), number of cycles planned and number completed.

Medical records supporting any prior therapies when relevant (e.g., prior fluorouracil-based chemotherapy, prior lines of therapy for salvage regimens), if applicable to the chosen regimen.

Laboratory results when dose holds or reductions are required: absolute neutrophil count (ANC) and platelet counts to document thresholds (ANC ≥ 1.5 × 10^9/L; platelets ≥ 75 × 10^9/L) before resuming therapy.

Key Coverage Criteria

C18.0-C20 Malignant neoplasm of colon and rectum
96401-96450 Chemotherapy administration
Gastric cancer.
C44.500 Unspecified malignant neoplasm of anal skin [metastatic anal cancer]
Biliary tract cancers, including intrahepatic and extrahepatic cholangiocarcinoma and gallbladder cancer.
C25.0-C25.9 Malignant neoplasm of pancreas

4 Active Policies

BCBSNJ-DRUGS-094-12BEA584EF, Oxaliplatin (Eloxatin)

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

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

AETNA-CPB-0683, Oxaliplatin

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J9263, Injection, oxaliplatin, 0.5 mg