HCPCS Level II › J codes J0571 Buprenorphine oral 1mgBuprenorphine, oral, 1 mg
Medicare coverage: Special coverage instructions apply Status: active (October 2026 file) Medically Unlikely Edits (effective October 1, 2026) Practitioner: max 0 units per day (clinical), rationale: Oral Medication; Not Payable Outpatient hospital: max 0 units per day (clinical), rationale: Oral Medication; Not Payable DME supplier: max 0 units per day (clinical), rationale: CMS Policy Medicare pricing for J0571 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J0571 0 of 1 payer prior-auth lists that name J0571 require prior authorization or set conditions.
Payer coverage policies that name J0571 J0571 appears in 2 coverage policies from Aetna.
Payer Policy Role in policy Reviewed Document Aetna Extended-Release Buprenorphine Injectables (0910) listed, no stance Dec 30, 2025 payer document Aetna Injectable Medications (0020) listed, no stance (range J0278-J2543) Mar 5, 2026 payer document
Recent prior-auth changes Apr 1, 2025: PA removed, UnitedHealthcare Mar 1, 2025: PA added, UnitedHealthcare Jan 1, 2025: PA removed, UnitedHealthcare Medicaid fee-for-service Prior authorization required or conditional in VT.
AZ: $0.27 (outpatient_hospital), effective Jul 1, 2026 IN: $0.07 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2021 KS: $0.27 (default), effective Oct 1, 2026 MS: $0.52 (comprehensive), effective Jul 1, 2026 NE: $0.41 (injectables), effective Jul 1, 2026 OH: $2.65 (provider_administered_drugs), effective Jan 1, 2022 OK: $0.68 (physician, non-facility), effective Jul 1, 2026 VA: $1.00 (medical), effective Apr 1, 2017 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.07 (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.