Does J9276 require prior authorization?

Yes, J9276 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9276?

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

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`J9276`, Injection, zanidatamab-hrii, 2 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

Documentation requires initial authorization for 6 months.

Key Coverage Criteria

Ziihera is indicated for the treatment of adults with previously treated, unresectable or metastatic HER2-positive (IHC 3+) biliary tract cancer, as detected by an FDA-approved test.
Prescribed by an oncologist; patient is at least 18 years old; unresectable or metastatic HER2-positive (IHC 3+) biliary tract cancer confirmed by ISH; previously received at least one gemcitabine-based regimen; progressed after first-line therapy; Ziihera as monotherapy; adequate cardiac function (LVEF ≥50%, no MI or unstable angina in last 6 months, no troponin consistent with MI, no clinically significant cardiac disease); ECOG 0-1; prescribed within FDA-approved dosing regimen; initial autho [...]

Initial approval criteria: Patient is at least 18 years of age; AND Universal Criteria: LVEF within normal limits prior to initiating therapy and assessed at regular intervals; AND patient doesn't have untreated or symptomatic CNS metastases; AND females of reproductive potential must have a negative pregnancy test prior to the first dose and use contraception during therapy and for 4 months after last dose; AND Biliary Tract Cancers (HER2-positive IHC3+), used as single agent, used as subsequen [...]

11 Active Policies

ARKBLUE-ZANIDATAMAB-HRII-E-G-ZIIHERA-10229ED2B5, Zanidatamab-hrii (e.g., Ziihera)

HEALTHPARTNERS-CC-ENTRY-281808, Zanidatamab-hrii (Ziihera)

MULTI

HEALTHNET_OR-HNOR-ZANIDATAMAB-HRII-ZIIHERA-CP-PHAR-709-B340278126, Zanidatamab-hrii (Ziihera); CP.PHAR.709

MODA-MODA-MPS-ZIIHERA-A2E565E4F9, Ziihera (zanidatamab-hrii)

IBX-COMMERCIAL-08-02-39B-2EBFFF2E67, Zanidatamab-hrii (Ziihera)

IBX-MEDICARE-ADVANTAGE-MA08-182B-98107C2F3C, Zanidatamab-hrii (Ziihera)

BCBSTN-f76069c1b8, Zanidatamab-hrii (Ziihera)

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

AMERIHEALTH-COMMERCIAL-08-02-39B-4436B0D662, Zanidatamab-hrii (Ziihera)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-182B-8C1ED71334, Zanidatamab-hrii (Ziihera)

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

`J9276`, Injection, zanidatamab-hrii, 2 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

J9276, Injection, zanidatamab-hrii, 2 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

11 Active Policies

Related Codes

Have a follow-up question?

`J9276`, Injection, zanidatamab-hrii, 2 mg