Does J9999 require prior authorization?

Yes, J9999 requires prior authorization (high confidence). At least one active policy explicitly requires prior authorization.

What is the Medicare reimbursement rate for J9999?

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

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`J9999`, Not otherwise classified, antineoplastic drugs

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

Every Part A claim for NOC/unlisted drug, biologic, and radiopharmaceutical codes must include the appropriate NOC code and the appropriate diagnosis.
Every claim must include the appropriate revenue codes for the drug and for IV infusion when applicable.
Every claim must indicate the drug name, the National Drug Code (NDC) number, and the total dosage administered.
For claim submission, the required documentation must be included in the remarks field (Field Locator 80) on the UB-04 (CMS 1450) or the equivalent 5010 electronic claim field.
For Part B claims, follow the Palmetto GBA articles referenced on their website for additional required documentation specific to NOC drugs, biologics, and radiopharmaceuticals.
For oncology NOC submissions prior to a unique HCPCS code, include the diagnosis code for the specific FDA label indication or, if no adequate diagnosis code exists, a specific narrative description of the indication.

Key Coverage Criteria

For claims using not otherwise classified (NOC)/unlisted HCPCS codes J3490, J3590, J9999, A4641, or A9699 with limited or specific indications, submit required documentation in the claim remarks field (Field Locator 80 on the UB-04) or the equivalent 5010 electronic claim field so Palmetto GBA can ascertain FDA labeling indications have been met.
For oncology drugs or oncology radiopharmaceuticals submitted with NOC codes prior to assignment of a unique HCPCS code, include the diagnosis code that corresponds to the specific FDA label indication or, if no adequate diagnosis code exists, include a specific narrative description of the indication (e.g., 'squamous cell carcinoma').
Immune thrombocytopenic purpura (ITP) — treatment of ITP when all of the following are met: diagnosis of ITP; documented platelet count < 30 × 10^9/L; history of failure, contraindication, or intolerance to one of: Anti-D immunoglobulin, corticosteroids, immune globulin, thrombopoietin receptor agonist (TPO-RA) (e.g., eltrombopag, romiplostim), or splenectomy. (Initial authorization up to 12 months; reauthorization up to 12 months.)
Pemphigus vulgaris — treatment of moderate to severe pemphigus vulgaris. (Initial authorization up to 12 months; reauthorization up to 12 months.)
Wegener's granulomatosis (Granulomatosis with polyangiitis) or Microscopic polyangiitis — treatment when diagnosis is present and either patient is receiving concurrent glucocorticoids or has history of contraindication/intolerance to glucocorticoids. (Initial authorization up to 12 months; reauthorization up to 12 months.)
Autoimmune hemolytic anemia (AIHA), including chronic cold agglutinin disease — treatment of AIHA. (Initial authorization up to 12 months; reauthorization up to 12 months.)

20 Active Policies

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

A54880, Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications

UHC-POL-rituxan-rituximab, Rituximab (Riabni, Rituxan, Ruxience, & Truxima)

AETNA-CPB-0245, Tumor Chemosensitivity Assays

BCBSIL-MED203.002, Antineoplaston Cancer Therapy

BCBSIL-RX501.140, Denosumab and Biosimilars for Non-Oncologic Indications

BCBSIL-RX501.066, Eculizumab and Associated Biosimilar(s)

BCBSIL-RX501.087, FDA - Drugs, Biologicals, Cellular and Gene Therapies

BCBSIL-RX504.003, Immunoglobulin Therapy

BCBSIL-RX502.061, Oncology Medications

BCBSMT-MED203.002, Antineoplaston Cancer Therapy

BCBSMT-RX501.140, Denosumab and Biosimilars for Non-Oncologic Indications

BCBSMT-RX501.066, Eculizumab and Associated Biosimilar(s)

BCBSMT-RX501.087, FDA - Drugs, Biologicals, Cellular and Gene Therapies

BCBSMT-RX504.003, Immunoglobulin Therapy

BCBSMT-RX502.061, Oncology Medications

BCBSNM-MED203.002, Antineoplaston Cancer Therapy

BCBSNM-RX501.140, Denosumab and Biosimilars for Non-Oncologic Indications

BCBSNM-RX501.066, Eculizumab and Associated Biosimilar(s)

Have a follow-up question?

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

Ask Backwork about J9999 Sign up free

J9999, Not otherwise classified, antineoplastic drugs

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

Every Part A claim for NOC/unlisted drug, biologic, and radiopharmaceutical codes must include the appropriate NOC code and the appropriate diagnosis.
Every claim must include the appropriate revenue codes for the drug and for IV infusion when applicable.
Every claim must indicate the drug name, the National Drug Code (NDC) number, and the total dosage administered.
For claim submission, the required documentation must be included in the remarks field (Field Locator 80) on the UB-04 (CMS 1450) or the equivalent 5010 electronic claim field.
For Part B claims, follow the Palmetto GBA articles referenced on their website for additional required documentation specific to NOC drugs, biologics, and radiopharmaceuticals.
For oncology NOC submissions prior to a unique HCPCS code, include the diagnosis code for the specific FDA label indication or, if no adequate diagnosis code exists, a specific narrative description of the indication.

Key Coverage Criteria

For claims using not otherwise classified (NOC)/unlisted HCPCS codes J3490, J3590, J9999, A4641, or A9699 with limited or specific indications, submit required documentation in the claim remarks field (Field Locator 80 on the UB-04) or the equivalent 5010 electronic claim field so Palmetto GBA can ascertain FDA labeling indications have been met.
For oncology drugs or oncology radiopharmaceuticals submitted with NOC codes prior to assignment of a unique HCPCS code, include the diagnosis code that corresponds to the specific FDA label indication or, if no adequate diagnosis code exists, include a specific narrative description of the indication (e.g., 'squamous cell carcinoma').
Immune thrombocytopenic purpura (ITP) — treatment of ITP when all of the following are met: diagnosis of ITP; documented platelet count < 30 × 10^9/L; history of failure, contraindication, or intolerance to one of: Anti-D immunoglobulin, corticosteroids, immune globulin, thrombopoietin receptor agonist (TPO-RA) (e.g., eltrombopag, romiplostim), or splenectomy. (Initial authorization up to 12 months; reauthorization up to 12 months.)
Pemphigus vulgaris — treatment of moderate to severe pemphigus vulgaris. (Initial authorization up to 12 months; reauthorization up to 12 months.)
Wegener's granulomatosis (Granulomatosis with polyangiitis) or Microscopic polyangiitis — treatment when diagnosis is present and either patient is receiving concurrent glucocorticoids or has history of contraindication/intolerance to glucocorticoids. (Initial authorization up to 12 months; reauthorization up to 12 months.)
Autoimmune hemolytic anemia (AIHA), including chronic cold agglutinin disease — treatment of AIHA. (Initial authorization up to 12 months; reauthorization up to 12 months.)

20 Active Policies

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

A54880, Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications

UHC-POL-rituxan-rituximab, Rituximab (Riabni, Rituxan, Ruxience, & Truxima)

AETNA-CPB-0245, Tumor Chemosensitivity Assays

BCBSIL-MED203.002, Antineoplaston Cancer Therapy

BCBSIL-RX501.140, Denosumab and Biosimilars for Non-Oncologic Indications

BCBSIL-RX501.066, Eculizumab and Associated Biosimilar(s)

BCBSIL-RX501.087, FDA - Drugs, Biologicals, Cellular and Gene Therapies

BCBSIL-RX504.003, Immunoglobulin Therapy

BCBSIL-RX502.061, Oncology Medications

BCBSMT-MED203.002, Antineoplaston Cancer Therapy

BCBSMT-RX501.140, Denosumab and Biosimilars for Non-Oncologic Indications

BCBSMT-RX501.066, Eculizumab and Associated Biosimilar(s)

BCBSMT-RX501.087, FDA - Drugs, Biologicals, Cellular and Gene Therapies

BCBSMT-RX504.003, Immunoglobulin Therapy

BCBSMT-RX502.061, Oncology Medications

BCBSNM-MED203.002, Antineoplaston Cancer Therapy

BCBSNM-RX501.140, Denosumab and Biosimilars for Non-Oncologic Indications

BCBSNM-RX501.066, Eculizumab and Associated Biosimilar(s)

Have a follow-up question?

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

Ask Backwork about J9999 Sign up free

`J9999`, Not otherwise classified, antineoplastic drugs

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9999`, Not otherwise classified, antineoplastic drugs

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9999, Not otherwise classified, antineoplastic drugs

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

J9999, Not otherwise classified, antineoplastic drugs

Prior Authorization

Medicare Pricing

Documentation Required

Key Coverage Criteria

20 Active Policies

Related Codes

Have a follow-up question?

`J9999`, Not otherwise classified, antineoplastic drugs

`J9999`, Not otherwise classified, antineoplastic drugs