J2679 Inj fluphenazine hcl 1.25 mgInjection, fluphenazine hcl, 1.25 mg
J2679 payment limit: $7.269 per 1.25 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
63323-0281-10 Fluphenazine HCl, FreseniUS Kabi USA, LLC: 20 billing units per package (1 VIAL in 1 BOX / 10 mL in 1 VIAL)Status E: excluded from the PFS by regulation.
2 of 4 payer prior-auth lists that name J2679 require prior authorization or set conditions: UnitedHealthcare Community Plan.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| UnitedHealthcare Community Plan | Pennsylvania CHIP | PA | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania CHIP Effective July 1, 2026 | |
| UnitedHealthcare Community Plan | Pennsylvania Medicaid | PA | prior auth required | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Pennsylvania Effective July 1, 2026 |
J2679 appears in 2 coverage policies from Aetna.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Injectable Medications (0020) | listed, no stance (range J2550-J3520) | Mar 5, 2026 | payer document |
| Aetna | Tourette's Syndrome (0480) Tetrabenazine | covered if criteria are met | Jul 24, 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.