Does J9380 require prior authorization?

Yes, J9380 requires prior authorization (high confidence). Code explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9380?

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

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`J9380`, Injection, teclistamab-cqyv, 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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.
Coverage determinations must include review of the member's benefit contract or SPD for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).
Documentation: Chart notes or medical record documentation demonstrating failure of previous lines of therapy is required to initiate prior authorization.

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.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Oncology medications may be considered medically necessary when the drug (a) is FDA-approved for an oncologic indication and used per FDA labeling, or (b) has NCCN Category 1/2A/2B recommendation per NCCN Guidelines or NCCN Compendium.

20 Active Policies

ARKBLUE-TECLISTAMAB-CQYV-E-G-TECVAYLI-2AE92DC6B5, Teclistamab-cqyv (e.g., Tecvayli)

BCBSM-2169904-2EA130112B, TECVAYLI (TECLISTAMAB-CQYV)

HEALTHPARTNERS-CC-ENTRY-287054, Oncology - teclistamab-cqyv (Tecvayli)

MULTI

POINT32HEALTH-MDMNG-14046, Tecvayli (teclistamab-cqyv)

MULTI

POINT32HEALTH-MDMNG-14056, Tecvayli (teclistamab-cqyv)

MULTI

MODA-TECVAYLI-4196703E80, Tecvayli (teclistamab-cqyv)

HEALTHNET_OR-HNOR-TECLISTAMAB-CQYV-TECVAYLI-CP-PHAR-611-FCEE4DB0DF, Teclistamab-cqyv (Tecvayli); CP.PHAR.611

IBX-MEDICARE-ADVANTAGE-MA08-156D-FC754E84D7, Teclistamab-cqyv (Tecvayli)

IBX-COMMERCIAL-08-01-98D-BA246A0C72, Teclistamab-cqyv (Tecvayli)

BCBSOK-RX502.061, Oncology Medications

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-08-01-98D-7477B40F03, Teclistamab-cqyv (Tecvayli)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-156D-4B8A0BBE06, Teclistamab-cqyv (Tecvayli)

BCBSTN-8672b06916, Teclistamab-cqyv (Tecvayli)

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

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

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

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J9380, Injection, teclistamab-cqyv, 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

Procedure codes listed are for general reference and may not be all-inclusive.
Benefit coverage/reimbursement determinations must be based on the written coverage position in the Medical Policy, not on the presence or absence of listed codes.
Coverage determinations must include review of the member's benefit contract or SPD for coverage definitions, exclusions, and limitations (e.g., dollar or duration caps).
Documentation: Chart notes or medical record documentation demonstrating failure of previous lines of therapy is required to initiate prior authorization.

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.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Medically necessary when the drug is FDA‑approved and administered in accordance with FDA labeling for an oncologic indication.
Medically necessary when the drug has an NCCN category 1, 2A, or 2B recommendation or is listed in the NCCN Drugs & Biologics Compendium.
Oncology medications may be considered medically necessary when the drug (a) is FDA-approved for an oncologic indication and used per FDA labeling, or (b) has NCCN Category 1/2A/2B recommendation per NCCN Guidelines or NCCN Compendium.

20 Active Policies

ARKBLUE-TECLISTAMAB-CQYV-E-G-TECVAYLI-2AE92DC6B5, Teclistamab-cqyv (e.g., Tecvayli)

BCBSM-2169904-2EA130112B, TECVAYLI (TECLISTAMAB-CQYV)

HEALTHPARTNERS-CC-ENTRY-287054, Oncology - teclistamab-cqyv (Tecvayli)

MULTI

POINT32HEALTH-MDMNG-14046, Tecvayli (teclistamab-cqyv)

MULTI

POINT32HEALTH-MDMNG-14056, Tecvayli (teclistamab-cqyv)

MULTI

MODA-TECVAYLI-4196703E80, Tecvayli (teclistamab-cqyv)

HEALTHNET_OR-HNOR-TECLISTAMAB-CQYV-TECVAYLI-CP-PHAR-611-FCEE4DB0DF, Teclistamab-cqyv (Tecvayli); CP.PHAR.611

IBX-MEDICARE-ADVANTAGE-MA08-156D-FC754E84D7, Teclistamab-cqyv (Tecvayli)

IBX-COMMERCIAL-08-01-98D-BA246A0C72, Teclistamab-cqyv (Tecvayli)

BCBSOK-RX502.061, Oncology Medications

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-08-01-98D-7477B40F03, Teclistamab-cqyv (Tecvayli)

AMERIHEALTH-MEDICARE-ADVANTAGE-MA08-156D-4B8A0BBE06, Teclistamab-cqyv (Tecvayli)

BCBSTN-8672b06916, Teclistamab-cqyv (Tecvayli)

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

BCBSIL-RX502.061, Oncology Medications

BCBSMT-RX502.061, Oncology Medications

Have a follow-up question?

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

Ask Backwork about J9380 Sign up free

`J9380`, Injection, teclistamab-cqyv, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9380`, Injection, teclistamab-cqyv, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9380, Injection, teclistamab-cqyv, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9380, Injection, teclistamab-cqyv, 0.5 mg

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9380`, Injection, teclistamab-cqyv, 0.5 mg

`J9380`, Injection, teclistamab-cqyv, 0.5 mg