Drugs and Biologicals, Coverage of, for Label and Off-Label Uses
J6 · Effective Oct 1, 2015
6 active Medicare policies list J1952, and 11 commercial payer policies list it. See each policy's status for the code and its official source. Listing a code is not a coverage decision: read each policy’s source for the requirements that apply.
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J6 · Effective Oct 1, 2015
JK · Effective Oct 1, 2015
JJ · Effective Feb 19, 2023
JM · Effective Feb 19, 2023
J6 · Effective Oct 1, 2025
National · Effective Oct 1, 2025
11 policies from 9 payers
Summary of the payer’s published policy. Not a coverage determination — confirm with the payer before submitting.
Codes labeled “Inferred from policy title” are not listed in the policy document; Backwork attached them because the policy title names the drug.
| Policy | Effective | Status of J1952 |
|---|---|---|
| Leuprolide (Camcevi, Camcevi ETM, Eligard, Fensolvi, Lupron Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Leuprolide (Camcevi, Camcevi ETM, Eligard, Fensolvi, Lupron Depot) | Not recorded | Covered with conditionsInferred from policy title |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Leuprolide (Camcevi, Camcevi ETM, Eligard, Fensolvi, Lupron Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Leuprolide (Camcevi, Camcevi ETM, Eligard, Fensolvi, Lupron Depot) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Leuprolide Mesylate (Camcevi ETM; Camcevi Kit) | May 1, 2004 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Leuprolide Acetate (Eligard, Fensolvi, Lupron Depot, Lupron Depot-Ped), Leuprolide mesylate (Camcevi); CP.PCH.53. | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Q3 - 2026 Jefferson Health Plans MedOnc Master Drug List | Not recorded | Prior auth required |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Gonadotropin Releasing Hormone Analogs | Jul 1, 2025 | Covered |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Gonadotropin Releasing Hormone Analogs | Jul 1, 2025 | Covered |
| Policy | Effective | Status of J1952 |
|---|---|---|
| Gonadotropin Releasing Hormone Analogs | Jul 1, 2025 | Covered |