J8565 Gefitinib oral

Gefitinib, oral, 250 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J8565

Physician Fee Schedule (CY 2026, RVU26D)

Status I: not valid for Medicare (Medicare uses another code).

Payer policies and prior authorization for J8565

Payer coverage policies that name J8565

J8565 appears in 6 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
AetnaCetuximab (Erbitux) (0684)
Afitinib		listed, no stanceDec 3, 2025payer document
AetnaPembrolizumab Products (Keytruda and Keytruda Qlex) (0890)listed, no stanceJul 14, 2026payer document
AetnaPharmacogenetic and Pharmacodynamic Testing (0715)listed, no stanceOct 8, 2026payer document
AetnaRevakinagene Taroretcel-lwey (Encelto) (1079)listed, no stance (range J8501-J9999)Oct 5, 2026payer document

Medicaid fee-for-service

  • AZ: $133.17 (outpatient_hospital), effective Apr 1, 2026
  • IL: $106.89 (practitioner), effective Apr 1, 2026
  • IN: $118.85 (professional, Advanced Practice Nurse (85%), non-facility), effective Jul 1, 2023
  • KY: $0.00 (asc), effective Jan 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 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.