J8700 Temozolomide

Temozolomide, oral, 5 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J8700

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

J8700 payment limit: $0.208 per 5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.

NDCs that bill under J8700 (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 J8700

11 of 11 payer prior-auth lists that name J8700 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), HealthSpring, 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.

PayerPlanStatePrior authConditionsSinceSource
Blue Cross Blue Shield of Arizona (AZ Blue)AZ Blue-administered Medicare Advantage (M2K)AZprior auth requiredSep 1, 2026AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)Standard PA code list (most commercial plans)AZprior auth requiredRequest from member's PBMSep 1, 2026AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)State of Arizona employee group (SYD, S3Z)AZprior auth requiredRequest from member's PBMSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)Teamsters group (TYW)AZprior auth requiredRequest from member's PBMSep 1, 2026Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026)
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
Molina Healthcare of FloridaMedicare AdvantageFLprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Florida), effective Q2 2021
Molina Healthcare of IdahoMedicare AdvantageIDprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Idaho), effective Q2 2021
Molina Healthcare of New MexicoMedicare AdvantageNMprior auth requiredJan 1, 2021Medicare Prior Auth (PA) Code Matrix (New Mexico), effective Q1 2021
Molina Healthcare of South CarolinaMedicare AdvantageSCprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (South Carolina), effective Q2 2021
Molina Healthcare of UtahMedicare AdvantageUTprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Utah), effective Q2 2021
Molina Healthcare of WashingtonMedicare AdvantageWAprior auth requiredApr 1, 2021Medicare Prior Auth (PA) Code Matrix (Washington), effective Q2 2021

Payer coverage policies that name J8700

J8700 appears in 7 coverage policies from Aetna, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaAntiemetic Therapy (0724)listed, no stanceJul 17, 2026payer document
AetnaBevacizumab for Non-Ocular Indications (0685)listed, no stanceApr 7, 2026payer document
AetnaElectric Tumor Treatment Fields (0827)covered if criteria are metFeb 18, 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
AetnaTemozolomide (Temodar) Injection (0876)listed, no stanceJun 3, 2026payer document
CenteneTemozolomide (Temodar) (CP.PHAR.77)covered if criteria are metMay 1, 2026payer document

Recent prior-auth changes

  • Jan 1, 2025: PA removed, UnitedHealthcare
  • Jan 1, 2023: PA removed, Molina Healthcare of Ohio
  • Oct 1, 2021: PA removed, Molina Healthcare of Wisconsin
  • Jul 1, 2021: PA removed, Molina Healthcare, Inc. (national grid)

Medicaid fee-for-service

  • AZ: $0.43 (outpatient_hospital), effective Jul 1, 2026
  • IL: $0.40 (practitioner), effective Apr 1, 2026
  • IN: $0.91 (professional, Advanced Practice Nurse (85%), non-facility), effective Apr 1, 2022
  • KY: $0.00 (asc), effective Jan 1, 2026
  • NE: $0.42 (injectables), effective Jul 1, 2026
  • OH: $0.42 (provider_administered_drugs), effective Jul 1, 2026
  • OK: $0.43 (physician, non-facility), effective Jul 1, 2026
  • VA: $0.42 (medical), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $0.43 (professional_administered_drugs), effective Jul 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.