HCPCS Level II › J codes J0572 Bupren/nal up to 3mg buprenoBuprenorphine/naloxone, oral, less than or equal to 3 mg buprenorphine
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 J0572 Physician Fee Schedule (CY 2026, RVU26D) Status E: excluded from the PFS by regulation.
Payer policies and prior authorization for J0572 0 of 2 payer prior-auth lists that name J0572 require prior authorization or set conditions.
Payer coverage policies that name J0572 J0572 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: $3.65 (outpatient_hospital), effective Oct 1, 2023 IN: $0.54 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2025 KS: $1.12 (default), effective Oct 1, 2026 MS: $2.48 (comprehensive), effective Jul 1, 2026 OH: $9.89 (provider_administered_drugs), effective Apr 1, 2022 OK: $1.14 (physician, non-facility), effective Jul 1, 2026 VA: $4.34 (medical), effective Apr 1, 2017 VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026 WA: $0.43 (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.