`J0275` Alprostadil urethral suppos

Alprostadil urethral suppository (code may be used for medicare when drug administered under the direct supervision of a physician, not for use when drug is self administered)

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

Practitioner: max 1 units per day (clinical), rationale: Prescribing Information
Outpatient hospital: max 1 units per day (clinical), rationale: Prescribing Information
DME supplier: max 0 units per day (clinical), rationale: CMS Policy

Medicare pricing for J0275

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J0275

1 of 1 payer prior-auth lists that name J0275 require prior authorization or set conditions: UnitedHealthcare Community Plan.

Payer	Plan	State	Prior auth	Conditions	Since	Source
UnitedHealthcare Community Plan	UnitedHealthcare Community Plan of New York	NY	prior auth required		Oct 1, 2026	Prior authorization requirements for UnitedHealthcare Community Plan of New York Effective October 1, 2026

Payer coverage policies that name J0275

J0275 appears in 2 coverage policies from Aetna, Centene.

Payer	Policy	Role in policy	Reviewed	Document
Aetna	Erectile Dysfunction and Peyronie's Disease (0007)	covered if criteria are met	Jul 29, 2026	payer document
Centene	Alprostadil (Caverject, Edex, Muse) (CP.CPA.02)	covered if criteria are met	Aug 1, 2026	payer document

Recent prior-auth changes

Nov 1, 2025: PA removed, UnitedHealthcare
Apr 1, 2025: conditions changed, UnitedHealthcare
Mar 1, 2025: conditions changed, UnitedHealthcare
Feb 1, 2025: PA removed, UnitedHealthcare Community Plan

Medicaid fee-for-service

Prior authorization required or conditional in IN, NY.

VA: $25.72 (medical), effective Jan 1, 2011
VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
WA: $56.82 (professional_administered_drugs), effective Jul 1, 2026
WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), effective Apr 1, 2026

From payers' published prior-auth lists, coverage policies and state Medicaid fee schedules, updated Oct 16, 2026. The role is what the policy's own code table or text says about the code. Not a guarantee of coverage or payment; verify with the payer. CPT® is a registered trademark of the American Medical Association.

J0275 Alprostadil urethral suppos