J8560 Etoposide oral 50 mg

Etoposide; oral, 50 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J8560

Medicare Part B drug payment limit (ASP, October 2026)

J8560 payment limit: $88.164 per 50 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J8560 (CMS ASP NDC-HCPCS crosswalk, October 2026)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J8560

1 of 1 payer prior-auth lists that name J8560 require prior authorization or set conditions: HealthSpring.

PayerPlanStatePrior authConditionsSinceSource
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List

Payer coverage policies that name J8560

J8560 appears in 11 coverage policies from Aetna.

PayerPolicyRole in policyReviewedDocument
AetnaAntiemetic Therapy (0724)listed, no stanceJul 17, 2026payer document
AetnaAtezolizumab (Tecentriq) and Atezolizumab and Hyaluronidase-tqjs (Tecentriq Hybreza) (0909)listed, no stanceSep 28, 2026payer document
AetnaBendamustine Products (0875)listed, no stanceSep 15, 2026payer document
AetnaBrentuximab Vedotin (Adcetris) (0823)listed, no stanceSep 24, 2026payer document
AetnaClofarabine (0867)listed, no stanceDec 24, 2025payer document
AetnaDaratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro) (0904)
Pomalidomide, lenalidomide, thalidomide, Selinexor, Venetoclax		listed, no stanceJun 8, 2026payer document
AetnaEmapalumab-lzsg (Gamifant) (0948)listed, no stanceDec 8, 2025payer document
AetnaHematopoietic Colony-Stimulating Factors (CSFs) (0055)listed, no stanceJul 16, 2026payer document
AetnaLurbinectedin (Zepzelca) (0978)listed, no stanceMar 11, 2026payer document
AetnaPembrolizumab Products (Keytruda and Keytruda Qlex) (0890)listed, no stanceJul 14, 2026payer document
AetnaRevakinagene Taroretcel-lwey (Encelto) (1079)listed, no stance (range J8501-J9999)Oct 5, 2026payer 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

  • AZ: $82.45 (asc), effective Oct 1, 2026
  • IL: $868.40 (practitioner), effective Apr 1, 2026
  • IN: $77.25 (professional, Advanced Practice Nurse (85%), non-facility), effective Oct 1, 2025
  • KY: $86.79 (asc), effective Jan 1, 2026
  • MS: $86.79 (comprehensive), effective Jul 1, 2026
  • NE: $88.05 (injectables), effective Jul 1, 2026
  • OH: $88.06 (provider_administered_drugs), effective Jul 1, 2026
  • OK: $88.06 (physician, non-facility), effective Jul 1, 2026
  • VA: $88.05 (medical), effective Jul 1, 2026
  • VT: $58.87 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $88.06 (professional_administered_drugs), effective Jul 1, 2026
  • WY: $37.59 (outpatient_hospital_apc, Ambulatory Surgical Centers), 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.