J9046 Inj, bortezomib, dr. reddy's

Injection, bortezomib (dr. reddy's), not therapeutically equivalent to j9041, 0.1 mg

Medically Unlikely Edits (effective October 1, 2026)

Medicare pricing for J9046

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J9046

45 of 45 payer prior-auth lists that name J9046 require prior authorization or set conditions: Aetna, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Shield of California Promise Health Plan, CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of California, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Ohio, Molina Healthcare of Texas, Molina Healthcare of Utah, Passport by Molina Healthcare (Kentucky), UnitedHealthcare, UnitedHealthcare Community Plan.

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 under conditionsplace of service 19, 22; site of care: outpatient hospitalSep 1, 2026AZ Blue Standard Prior Authorization Requirements Code List (09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)Standard PA code list (most commercial plans)AZprior auth under conditionssite of care: site-of-service reviewSep 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 requiredsite of care: site-of-service reviewSep 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 under conditionsplace of service 19, 22; site of care: outpatient hospitalSep 1, 2026Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Shield of California Promise Health PlanPromise Health Plan Medi-CalCAprior auth requiredSep 1, 2026Medi-Cal Prior Authorization List
AetnaMedicare AdvantageAllprior auth requiredAug 25, 2026Aetna Medicare Part B drug list (partbname.xml)
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsJan 1, 2023Master Precertification List (For Health Care Providers)
CignaBasic StandardAllprior auth requiredMay be delegated to eviCore for some clientsJan 1, 2023Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsJan 1, 2023Master Precertification List (For Health Care Providers)
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
CarePlus Health PlansCarePlus Health PlansFLprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans Prior Authorization and Notification List We have updated our CarePlus Health Plans Prior Authorization and Notification List for CarePlus Medi
HumanaHumana D-SNP (FL)FLprior auth requiredJul 1, 2026H1036-280 Humana Fully Integrated Florida prior authorization and notification list
HumanaHumana D-SNP (IL)ILprior auth requiredJan 1, 2027Humana Dual Fully Integrated Illinois prior authorization and notification list
HumanaHumana D-SNP (IN)INprior auth requiredJan 1, 2027Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
HumanaHumana D-SNP (MI)MIprior auth requiredOct 14, 2026Humana Dual Integrated (health maintenance organization Dual Eligible Special Needs Plan (HMO D- SNP) Michigan prior authorization and notification list (PAL)
HumanaHumana D-SNP (SC)SCprior auth requiredJul 1, 2026Humana Dual Integrated South Carolina prior authorization and notification list
HumanaHumana D-SNP (VA)VAprior auth requiredJul 1, 2026Prior authorization and notification list Humana Dual Fully Integrated H2875-001 (Virginia) Humana Dual Fully Integrated H2875-003 (Virginia)
HumanaHumana Healthy HorizonsKYprior auth requiredOct 7, 2026Humana Healthy Horizons in Kentucky Prior Authorization and Notification List
HumanaHumana Healthy HorizonsLAprior auth requiredOct 14, 2026Humana Healthy Horizons in Louisiana Prior Authorization and Notification List
HumanaHumana Healthy HorizonsOHprior auth requiredOct 14, 2026Humana Healthy Horizons in Ohio prior authorization and notification List
HumanaHumana Healthy HorizonsSCprior auth requiredOct 14, 2026Humana Healthy Horizons in South Carolina prior authorization and notification list
HumanaHumana Healthy HorizonsVAprior auth requiredOct 14, 2026Humana Healthy Horizons in Virginia professionally administered medication prior authorization and notification list
HumanaHumana MA and D-SNPAllprior auth requiredJan 1, 2027Medicare Advantage and Dual Eligible Special Needs Plans prior authorization and notification list Important notes:
Molina Complete Care (Virginia)MedicaidVAprior auth requiredApr 1, 2025Virginia Medicaid PA Code Matrix and Virginia code/benefit exceptions, effective Q2 2025
Molina Healthcare of CaliforniaMedicaidCAprior auth requiredApr 1, 2026Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of IdahoMedicaidIDprior auth requiredJan 1, 2025Idaho Medicaid Prior Auth (PA) Code Matrix and Idaho code/benefit exceptions, Q1 2025
Molina Healthcare of IllinoisMedicaidILprior auth requiredJan 1, 2022Molina Healthcare of Illinois Codification Grid Q3 2026
Molina Healthcare of IowaMedicaidIAprior auth requiredJul 1, 2023IA Prior Authorization Matrix, effective Q3 2023
Molina Healthcare of MichiganMedicare AdvantageMIprior auth requiredJul 1, 2026Molina Healthcare of Michigan PA Matrix 2026-Q3
Molina Healthcare of MississippiMedicaidMSprior auth requiredcancer dx via EvolentJan 1, 2025Mississippi Medicaid Prior Auth (PA) Code Matrix and exceptions, effective Q1 2025
Molina Healthcare of OhioMedicaid and MyCare Ohio (MMP) MedicaidOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioMedicare and MyCare Ohio (MMP) MedicareOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of OhioExchangeOHprior auth requiredOct 1, 2023Molina Healthcare of Ohio Prior Authorization (PA) Code List, effective 2023-10-01
Molina Healthcare of TexasExchangeTXprior auth requiredJan 1, 2023Marketplace Prior Authorization (PA) Code Matrix (Texas), effective July 1, 2026
Molina Healthcare of UtahMedicaidUTprior auth requiredJan 1, 2025Utah Medicaid Prior Auth (PA) Code Matrix and Utah code/benefit exceptions, Q1 2025
Passport by Molina Healthcare (Kentucky)MedicaidKYprior auth requiredcancer dx via EvolentJul 1, 2026Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 2026
UnitedHealthcareUnitedHealthcare Complete (Individual & Family plans)Allprior auth requiredSep 1, 2026Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026
UnitedHealthcareUnitedHealthcare Individual Exchange plansAllprior auth requiredOct 1, 2026Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026
UnitedHealthcare Community PlanTexas CHIPTXprior auth under conditionssite of care: outpatientMay 1, 2023Prior authorization requirements for Texas CHIP Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan Texas CHIP health care
UnitedHealthcare Community PlanTexas STARTXprior auth under conditionssite of care: outpatientMay 1, 2023Prior authorization requirements for Texas STAR Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR h
UnitedHealthcare Community PlanTexas STAR KidsTXprior auth under conditionssite of care: outpatientMay 1, 2023Prior authorization requirements for STAR Kids Effective September 1, 2026 This list contains prior authorization review requirements for participating UnitedHealthcare Community Plan of Texas STAR Ki
UnitedHealthcare Community PlanTexas STAR+PLUSTXprior auth under conditionssite of care: outpatientMay 1, 2023Prior authorization requirements for STAR+Plus Effective September 1, 2026 This list contains prior authorization requirements for participating UnitedHealthcare Community Plan STAR+PLUS health care p
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of Hawaii (QUEST Integration)HIprior auth under conditionssite of care: outpatientOct 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026
UnitedHealthcare Community PlanUnitedHealthcare Community Plan of KentuckyKYprior auth under conditionssite of care: outpatientJul 1, 2026Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026

Payer coverage policies that name J9046

J9046 appears in 33 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Centene, Premera Blue Cross.

PayerPolicyRole in policyReviewedDocument
AetnaAntiemetic Therapy (0724)listed, no stanceJul 17, 2026payer document
AetnaBelantamab Mafodotin-blmf (Blenrep) (0981)
Ixazomib, Lenalidomide, Pomalidomide
listed, no stanceFeb 6, 2026payer document
AetnaBendamustine Products (0875)listed, no stanceSep 15, 2026payer document
AetnaBortezomib Products (0675)covered if criteria are metFeb 17, 2026payer document
AetnaCarfilzomib (Kyprolis) (0845)listed, no stanceMar 2, 2026payer document
AetnaCiltacabtagene Autoleucel (Carvykti) (1007)listed, no stanceMar 13, 2026payer document
AetnaDaratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro) (0904)
Pomalidomide, lenalidomide, thalidomide, Selinexor, Venetoclax
listed, no stanceJun 8, 2026payer document
AetnaElotuzumab (Empliciti) (0899)listed, no stanceMar 2, 2026payer document
AetnaElranatamab-bcmm (Elrexfio) (1040)listed, no stanceDec 10, 2025payer document
AetnaHematopoietic Cell Transplantation for Hodgkin's Disease (0495)listed, no stance (range J9000-J9999)Jul 2, 2026payer document
AetnaHematopoietic Cell Transplantation for Multiple Myeloma (0497)listed, no stance (range J9000-J9999)Aug 5, 2026payer document
AetnaHematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496)listed, no stance (range J9000-J9999)Aug 6, 2026payer document
AetnaHematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia (0626)listed, no stance (range J9000-J9999)Sep 18, 2026payer document
AetnaHematopoietic Colony-Stimulating Factors (CSFs) (0055)listed, no stanceJul 16, 2026payer document
AetnaInfusion Pumps (0161)covered if criteria are met (range J9000-J9999)Mar 31, 2026payer document
AetnaInjectable Medications (0020)listed, no stance (range J9000-J9999)Mar 5, 2026payer document
AetnaIsatuximab-irfc (Sarclisa) (0969)listed, no stanceMar 2, 2026payer document
AetnaLinvoseltamab-gcpt (Lynozyfic) (1089)listed, no stanceJul 17, 2026payer document
AetnaMargetuximab-cmkb (Margenza) (0985)listed, no stance (range J9000-J9999)May 27, 2026payer document
AetnaNegative Pressure Wound Therapy (0334)listed, no stance (range J9000-J9999)Jun 8, 2026payer document
AetnaPertuzumab Products (0973)listed, no stance (range J9000-J9999)Apr 27, 2026payer document
AetnaPhototherapy and Photochemotherapy (PUVA) for Skin Conditions (0205)listed, no stance (range J9000-J9999)May 18, 2026payer document
AetnaRadium Ra 223 Dichloride (Xofigo) (0874)listed, no stanceDec 22, 2025payer document
AetnaRevakinagene Taroretcel-lwey (Encelto) (1079)listed, no stance (range J8501-J9999)Oct 5, 2026payer document
AetnaTalquetamab-tgvs (Talvey) (1042)listed, no stanceOct 9, 2026payer document
AetnaTeclistamab-cqyv (Tecvayli) (1018)listed, no stanceJun 8, 2026payer document
AetnaTumor Chemoresistance Assays (0758)listed, no stance (range J9000-J9999)Dec 2, 2025payer document
AetnaTumor Chemosensitivity Assays (0245)listed, no stance (range J9000-J9999)Apr 13, 2026payer document
BlueCross BlueShield of South CarolinaHematopoietic Cell Transplantation for Breast Cancer (CAM 80127)listed, no stance (range J9000-J9999)Jul 1, 2026payer document
BlueCross BlueShield of South CarolinaHematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (CAM 80124)unproven / investigational (range J9000-J9999)Jul 1, 2026payer document
BlueCross BlueShield of South CarolinaHematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (CAM 80117)listed, no stance (range J9000-J9999)Jan 1, 2026payer document
CenteneBortezomib (Boruzu, Velcade) (CP.PHAR.410)covered if criteria are metFeb 1, 2026payer document
Premera Blue CrossMiscellaneous Oncology Drugs (5.01.540)listed, no stanceOct 1, 2026payer document

Recent prior-auth changes

  • Oct 14, 2026: PA removed, Humana
  • Jan 1, 2026: PA added, Molina Healthcare of Michigan
  • Nov 1, 2025: PA added, UnitedHealthcare Community Plan
  • Nov 1, 2025: PA added, UnitedHealthcare Community Plan
  • Nov 1, 2025: PA added, UnitedHealthcare Community Plan
  • Nov 1, 2025: PA added, UnitedHealthcare Community Plan
  • Apr 1, 2023: PA added, Molina Healthcare of Ohio
  • Apr 1, 2023: PA added, Molina Healthcare of Ohio
  • Apr 1, 2023: PA added, Blue Shield of California Promise Health Plan
  • Apr 1, 2023: PA added, Molina Healthcare of Ohio

Medicaid fee-for-service

Prior authorization required or conditional in VA, WA.

  • AZ: $3.29 (asc), effective Oct 1, 2026
  • IL: $1.72 (practitioner), effective Apr 1, 2026
  • IN: $6.38 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2023
  • KS: $48.55 (asc, facility), effective Jul 1, 2023
  • KY: $3.46 (asc), effective Jan 1, 2026
  • LA: $7.14 (professional), effective Jan 1, 2025
  • MS: $3.93 (comprehensive, facility), effective Oct 1, 2025
  • NE: $48.91 (injectables), effective Jul 1, 2026
  • OH: $48.55 (provider_administered_drugs), effective Jul 1, 2023
  • OK: $7.14 (physician, non-facility), effective Jul 1, 2026
  • TX: $8.57 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Sep 1, 2024
  • VA: $48.54 (medical), effective Jul 1, 2023
  • VT: $2.63 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $45.80 (professional_administered_drugs), effective Jul 1, 2026
  • WY: $1.50 (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.