Does J9400 require prior authorization?

Yes, J9400 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9400?

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 of 12 months may be granted for treatment of advanced or metastatic CRC, including anal adenocarcinoma and appendiceal adenocarcinoma, in combination with 5-fluorouracil, leucovorin, and irinotecan (FOLFIRI) or in combination with irinotecan.
Authorization of 12 months may be granted for continued treatment in members requesting reauthorization for an indication in the coverage criteria section when there is no evidence of unacceptable toxicity or disease progression while on the current regimen.

ARKBLUE-ZIV-AFLIBERCEPT-E-G-ZALTRAP-40B7E8B227, Ziv-aflibercept (e.g., Zaltrap)

BCBSM-2070037-D2953FDFE2, AIM MEDICAL POLICY - ZIV-AFLIBERCEPT: ZALTRAP (J9400) (RERTIRED AS OF 02/02/2023)

BCBSND-ZIV-AFLIBERCEPT-ZALTRAP-D491FBC553, ZIV Aflibercept Zaltrap

BCBSNE-X-37-23BC59A099, ZIV-AFLIBERCEPT/ZALTRAP

MODA-ZIV-AFLIBERCEPT-0A175C05B4, Zaltrap (ziv-aflibercept)

HEALTHNET_OR-HNOR-ZIV-AFLIBERCEPT-ZALTRAP-CP-PHAR-325-B409062D57, Ziv-aflibercept (Zaltrap); CP.PHAR.325

BCBSTN-66ef690ba3, Ziv-Aflibercept (Zaltrap)

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

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

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