Does J9307 require prior authorization?

Yes, J9307 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9307?

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

Authorization for 12 months for treatment of PTCL may be granted when the medication is used as a single agent and to treat relapsed or refractory disease or for initial palliative therapy.

BCBSND-PRALATREXATE-E7C45EFF84, Pralatrexate

HEALTHNET_OR-HNOR-PRALATREXATE-FOLOTYN-CP-PHAR-313-869B342551, Pralatrexate (Folotyn); CP.PHAR.313

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