Does J9334 require prior authorization?

Yes, J9334 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9334?

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

Backwork Sign up free

`J9334`, Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc

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

Documented confirmed diagnosis of anti-acetylcholine receptor (AChR) antibody positive generalized myasthenia gravis for gMG requests.
Documented age (>=18 years).
For gMG: documentation of prior or current pyridostigmine use or documentation that pyridostigmine was failed, contraindicated, or not tolerated.
For gMG: documentation of unresolved symptoms (examples: difficulty swallowing, difficulty breathing, or functional disability such as double vision, impaired speech, or impaired mobility) supporting medical necessity.
For gMG: documentation of MGFA classification (II to IV required) and baseline MG-ADL score (must be >=5).
For gMG re-authorization: documentation of ongoing clinical benefit (examples provided: reductions in exacerbations; improvements in speech, swallowing, mobility, respiratory function).

Key Coverage Criteria

Generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive — Vyvgart (intravenous formulation).
Generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive — Vyvgart Hytrulo (subcutaneous formulation).
Chronic inflammatory demyelinating polyneuropathy (CIDP) in adult patients — Vyvgart Hytrulo (subcutaneous formulation).
This policy addresses only the determination of medical necessity for the hospital outpatient setting for infusion and injectable therapy; the medical necessity of the pharmacologic or biologic medication itself may be reviewed separately.
Requests for select medications intended for administration in a hospital outpatient setting will be directed to a preferred alternative site of care (non-hospital affiliated outpatient facility or home).
Medically necessary for CIDP in adults (age >=18) after prior failure or contraindication to IVIg and corticosteroids.

20 Active Policies

ARKBLUE-EFGARTIGIMOD-ALFA-AND-HYALURONIDASE-QVFC-E-G-VYV-727D4857F6, Efgartigimod alfa and Hyaluronidase-qvfc (e.g., Vyvgart Hytrulo)

FLORIDA_BLUE-FLBLUE-EFGARTIGIMOD-ALFA-VYVGARTTM-AND-VYVGART-HYTRULO-EFGARTIGIMOD-6C34B6B051, efgartigimod alfa -Vyvgart and Vyvgart Hytrulo (efgartigimod alfa/hyaluronidase-qvfc)

BCBSLA-00790-C708843DC8, 00790 efgartigimod alfa (Vyvgart), efgartigimod alfa and hyaluronidase- human (Vyvgart Hytrulo)

HEALTHPARTNERS-CC-ENTRY-252184, Neonatal Fc receptor antagonists (Vyvgart, Vyvgart Hytrulo, Rystiggo, Imaavy)

MULTI

POINT32HEALTH-MDMNG-14321, Vyvgart (efgartigimod alfa-fcab) and Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)

MULTI

POINT32HEALTH-MDMNG-14331, Vyvgart (efgartigimod alfa-fcab), Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)

MULTI

MODA-VYVGART-SQ-0339F350D0, Vyvgart Hytrulo (efgartigimod alfa-fcab and hyaluronidase-qvfc)

HEALTHNET_OR-HNOR-EFGARTIGIMOD-ALFA-FCAB-EFGARTIGIMOD-HYALURONIDASE-QVFC-V-E3B73D871F, Efgartigimod Alfa-fcab, Efgartigimod/Hyaluronidase-qvfc (Vyvgart, Vyvgart Hytrulo); CP.PHAR.555

IBX-MEDICARE-ADVANTAGE-MA08-142E-424A2C53FC, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)

BCBSMT-ADM1001.034, Specialty Medication Administration Site of Care

BCBSNM-RX501.141, Efgartigimod alfa-fcab or Efgartigimod alfa and hyaluronidase-qvfc

BCBSNM-ADM1001.034, Specialty Medication Administration Site of Care

BCBSOK-RX501.141, Efgartigimod alfa-fcab or Efgartigimod alfa and hyaluronidase-qvfc

BCBSOK-ADM1001.034, Specialty Medication Administration Site of Care

UMR-POL-UMR-fcrn-blockers, FcRn Blockers

UMR-POL-UMR-provider-administered-drugs-soc, Provider Administered Drugs – Site of Care

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-142E-00E5047E1E, Efgartigimod alfa-fcab (Vyvgart) and efgartigimod-alfa and hyaluronidase-qvfc (Vyvgart Hytrulo)

SUREST-POL-SUREST-fcrn-blockers, FcRn Blockers

EVICORE-MEDICAL_DRUG-6D1AD8C33612, Vyvgart (efgartigimod alfa-fcab) Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)Effective 09/01/2026

EVICORE-MEDICAL_DRUG-C539E4E58BD2, Vyvgart (efgartigimod alfa-fcab) Vyvgart Hytrulo (efgartigimod alfa and hyaluronidase-qvfc)

Have a follow-up question?

Ask Backwork about documentation requirements, denial risks, or coverage in your state.

Ask Backwork about J9334 Sign up free

J9334, Injection, efgartigimod alfa, 2 mg and hyaluronidase-qvfc

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

Documented confirmed diagnosis of anti-acetylcholine receptor (AChR) antibody positive generalized myasthenia gravis for gMG requests.
Documented age (>=18 years).
For gMG: documentation of prior or current pyridostigmine use or documentation that pyridostigmine was failed, contraindicated, or not tolerated.
For gMG: documentation of unresolved symptoms (examples: difficulty swallowing, difficulty breathing, or functional disability such as double vision, impaired speech, or impaired mobility) supporting medical necessity.
For gMG: documentation of MGFA classification (II to IV required) and baseline MG-ADL score (must be >=5).
For gMG re-authorization: documentation of ongoing clinical benefit (examples provided: reductions in exacerbations; improvements in speech, swallowing, mobility, respiratory function).

Key Coverage Criteria

Generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive — Vyvgart (intravenous formulation).
Generalized myasthenia gravis (gMG) in adult patients who are anti-acetylcholine receptor (AChR) antibody positive — Vyvgart Hytrulo (subcutaneous formulation).
Chronic inflammatory demyelinating polyneuropathy (CIDP) in adult patients — Vyvgart Hytrulo (subcutaneous formulation).
This policy addresses only the determination of medical necessity for the hospital outpatient setting for infusion and injectable therapy; the medical necessity of the pharmacologic or biologic medication itself may be reviewed separately.
Requests for select medications intended for administration in a hospital outpatient setting will be directed to a preferred alternative site of care (non-hospital affiliated outpatient facility or home).
Medically necessary for CIDP in adults (age >=18) after prior failure or contraindication to IVIg and corticosteroids.