J1000 Depo-estradiol cypionate injInjection, depo-estradiol cypionate, up to 5 mg
J1000 payment limit: $53.805 per 5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
00009-0271-01 Depo-Estradiol, Pfizer Inc: 5 billing units per package (1 VIAL in 1 CARTON / 5 mL in 1 VIAL)Status E: excluded from the PFS by regulation.
9 of 9 payer prior-auth lists that name J1000 require prior authorization or set conditions: Molina Healthcare of Idaho, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky).
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Molina Healthcare of Idaho | Idaho state exceptions (exceptions only) | ID | prior auth under conditions | State exception; age under 18 | Jan 1, 2025 | Idaho code/benefit exceptions (Marketplace), Q1 2025 |
| Molina Healthcare of Idaho | Medicaid | ID | prior auth under conditions | State exception; age under 18 | Jan 1, 2025 | Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025 |
| Molina Healthcare of Iowa | Medicaid | IA | prior auth required | Jul 1, 2023 | IA Prior Authorization Matrix, effective Q3 2023 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth under conditions | age under 18 | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 |
| Molina Healthcare of Mississippi | Mississippi state exceptions (exceptions only) | MS | prior auth under conditions | State exception; age under 18 | Jan 1, 2025 | Mississippi code/benefit exceptions (Marketplace), 2025-Q1 |
| Molina Healthcare of Mississippi | Medicaid | MS | prior auth under conditions | State exception; age under 18 | Jan 1, 2025 | Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025 |
| Molina Healthcare of Utah | Utah state exceptions (exceptions only) | UT | prior auth required | State exception | Jan 1, 2025 | Utah code/benefit exceptions (Marketplace), Q1 2025 |
| Molina Healthcare of Utah | Medicaid | UT | prior auth required | State exception | Jan 1, 2025 | Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025 |
| Passport by Molina Healthcare (Kentucky) | Kentucky state exceptions to the Molina Marketplace grid (exceptions only) | KY | prior auth required | State exception; Medicaid: Not covered for certain indications as per House Bill 495 | Jul 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026 |
J1000 appears in 4 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Alzheimer's Disease: Experimental, Investigational, or Unproven Treatments (0788) | not covered | Nov 19, 2025 | payer document |
| Aetna | Gender Affirming Surgery (0615) | covered if criteria are met | Sep 8, 2026 | payer document |
| Aetna | Infertility (0327) | covered if criteria are met | Jul 16, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J0278-J2543) | Mar 5, 2026 | payer document |
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.