22 commercial payer policies list J9316. 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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22 policies from 20 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 J9316 |
|---|---|---|
| Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo) | Not recorded | Covered with conditionsInferred from policy title |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo) | Not recorded | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf (Phesgo) | 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 J9316 |
|---|---|---|
| Pertuzumab, trastuzumab and hyaluronidase-zzxf (e.g., PHESGO) | 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 J9316 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Oncology Medications | Jul 1, 2026 | Covered |
| Policy | Effective | Status of J9316 |
|---|---|---|
| PHESGO (PERTUZUMAB, TRASTUZUMAB AND HYALURONIDASE-ZZXF) J3590 | 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 J9316 |
|---|---|---|
| Pertuzumab Trastuzumab AND Hyaluronidase Zzxf Phesgo | 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 J9316 |
|---|---|---|
| Pertuzumab, Trastuzumab and Hyaluronidase-zzxf (Phesgo) | Sep 30, 2020 | Covered with conditionsInferred from policy title. Not listed in the policy document; attached because the policy title names the drug. |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Cigna MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Pertuzumab-trastuzumab-hyaluronidse-zzxf (Phesgo); CP.PHAR.501 | 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 J9316 |
|---|---|---|
| Q4 - 2026 JHP MedOnc Master Drug List.pdf | Not recorded | Prior auth required |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Oncology - pertuzumab, trastuzumab, and hyaluronidase-zzxf (Phesgo) – Minnesota Health Care Programs | 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 J9316 |
|---|---|---|
| Trastuzumab (Herceptin), Trastuzumab-dkst (Ogivri), Ado-trastuzumab emtansine (Kadcyla), Trastuzumab-pkrb (Herzuma), Trastuzumab-dttb (Ontruzant), Trastuzumab and Hyaluronidase-oysk (Herceptin Hylecta), Trastuzumab-qyyp (Trazimera), Trastuzumab-anns (Kanjinti), Fam-trastuzumab deruxtecan-nxki (Enhertu), Pertuzumab (Perjeta), and Pertuzumab, Trastuzumab, and hyaluronidase-zzxf (Phesgo) | 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 J9316 |
|---|---|---|
| Phesgo (pertuzumab, trastuzumab and hyaluronidase-zzxf) | 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 J9316 |
|---|---|---|
| Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf) | 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 J9316 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |
| Policy | Effective | Status of J9316 |
|---|---|---|
| Oncology Medication Clinical Coverage | Sep 1, 2026 | Covered |