Does J9289 require prior authorization?

Yes, J9289 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9289?

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

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`J9289`, Injection, nivolumab, 2 mg and hyaluronidase-nvhy

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 required: MSI-H/dMMR tumor status confirmation where applicable.
Documentation required: EGFR mutation or ALK rearrangement status where applicable.

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.
Indication: monotherapy for unresectable or metastatic melanoma in adults.
Indication: adjuvant monotherapy for completely resected melanoma (Stage IIB-IV).
Indication: first-line treatment of adult patients with intermediate or poor risk advanced RCC after progression on nivolumab/ipilimumab therapy.
Indication: first-line treatment of adult patients with advanced RCC in combination with cabozantinib.
Indication: monotherapy for adult patients with advanced RCC after progression on prior anti-angiogenic therapy.

13 Active Policies

ARKBLUE-NIVOLUMAB-AND-HYALURONIDASE-E-G-OPDIVO-QVANTIG-3F717A08C6, Nivolumab and Hyaluronidase (e.g., Opdivo Qvantig)

MODA-OPDIVO-QVANTIG-36992A7220, Opdivo Qvantig (nivolumab and hyaluronidase-nvhy)

HEALTHNET_OR-HNOR-NIVOLUMAB-OPDIVO-NIVOLUMAB-HYALURONIDASE-NVHY-OPDIVO-QVA-0857E3C437, Nivolumab (Opdivo), Nivolumab/Hyaluronidase-nvhy (Opdivo Qvantig); CP.PHAR.121

IBX-MEDICARE-ADVANTAGE-MA08-120G-02095D091D, Nivolumab (Opdivo), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)

IBX-COMMERCIAL-08-01-62G-41D667F6C7, Nivolumab (Opdivo), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)

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

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

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-08-01-62G-624EC04030, Nivolumab (Opdivo), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-120G-E40D29927E, Nivolumab (Opdivo), Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)

BCBSTN-e5ed893792, Nivolumab and Hyaluronidase-nvhy (Opdivo Qvantig)

`J9289`, Injection, nivolumab, 2 mg and hyaluronidase-nvhy

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

J9289, Injection, nivolumab, 2 mg and hyaluronidase-nvhy

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

13 Active Policies

Related Codes

Have a follow-up question?

`J9289`, Injection, nivolumab, 2 mg and hyaluronidase-nvhy