J3240 Thyrotropin injectionInjection, thyrotropin alpha, 0.9 mg, provided in 1.1 mg vial
J3240 payment limit: $2,155.112 per 0.9 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
58468-0030-02 Thyrogen, Genzyme Corporation: 2 billing units per package (2 VIAL, SINGLE-DOSE in 1 CARTON / 1 mL in 1 VIAL, SINGLE-DOSE)Status E: excluded from the PFS by regulation.
7 of 7 payer prior-auth lists that name J3240 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of New Mexico, Molina Healthcare of South Carolina, Molina Healthcare of Utah, Molina Healthcare of Washington.
| Payer | Plan | State | Prior auth | Conditions | Since | Source |
|---|---|---|---|---|---|---|
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) | |
| Molina Healthcare of Florida | Medicare Advantage | FL | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021 | |
| Molina Healthcare of Idaho | Medicare Advantage | ID | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021 | |
| Molina Healthcare of New Mexico | Medicare Advantage | NM | prior auth required | Jan 1, 2021 | Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021 | |
| Molina Healthcare of South Carolina | Medicare Advantage | SC | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021 | |
| Molina Healthcare of Utah | Medicare Advantage | UT | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021 | |
| Molina Healthcare of Washington | Medicare Advantage | WA | prior auth required | Apr 1, 2021 | Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021 |
J3240 appears in 3 coverage policies from Aetna, Centene.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Injectable Medications (0020) | listed, no stance (range J2550-J3520) | Mar 5, 2026 | payer document |
| Aetna | Thyrogen (Thyrotropin Alfa) (0515) | covered if criteria are met | Aug 5, 2026 | payer document |
| Centene | Thyrotropin Alfa (Thyrogen) (CP.PHAR.95) | covered if criteria are met | Aug 1, 2026 | payer document |
Prior authorization required or conditional in VA.
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.