J9074 Inj, cyclophosphamd, sandozInjection, cyclophosphamide (sandoz), 5 mg
J9074 payment limit: $3.238 per 5 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
00781-3528-10 Cyclophosphamide, Sandoz Inc.: 100 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 5 mL in 1 VIAL, MULTI-DOSE)00781-3529-10 Cyclophosphamide, Sandoz Inc.: 200 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 10 mL in 1 VIAL, MULTI-DOSE)00781-3530-10 Cyclophosphamide, Sandoz Inc.: 400 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 20 mL in 1 VIAL, MULTI-DOSE)Status E: excluded from the PFS by regulation.
20 of 24 payer prior-auth lists that name J9074 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), HealthSpring, Molina Healthcare of California, Neighborhood Health Partnership, Oxford Health Plans, Surest, UnitedHealthcare, UnitedHealthcare Community Plan.
| 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 | Oncology dx: eviCore | Sep 1, 2026 | AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026) |
| Blue Cross Blue Shield of Arizona (AZ Blue) | AZ Blue-administered Medicare Advantage (M2K) | AZ | prior auth required | Non-oncology dx: AZ Blue | Sep 1, 2026 | AZ 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) | AZ | prior auth under conditions | eviCore-delegated groups only | Sep 1, 2026 | AZ 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) | AZ | prior auth required | Sep 1, 2026 | State of Arizona Group Prior Authorization Requirements Code List (09/01/2026) | |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Neighborhood Health Partnership | Neighborhood Health Partnership | FL | prior auth under conditions | site of care: outpatient | Sep 1, 2026 | Prior authorization requirements for Neighborhood Health Partnership Effective September 1, 2026 |
| Oxford Health Plans | Oxford Health Plans | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior Authorization Requirements for Oxford Effective October 1, 2026 |
| Surest | Surest health plans | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior Authorization Requirements for Surest Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Commercial | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare commercial plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare Complete (Individual & Family plans) | All | prior auth required | Sep 1, 2026 | Prior authorization requirements for UnitedHealthcare Complete Effective September 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Individual Exchange plans | All | prior auth required | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Individual Exchange plans Effective October 1, 2026 | |
| UnitedHealthcare | UnitedHealthcare Mid-Atlantic Health Plans | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Mid-Atlantic Health Plans Effective October 1, 2026 |
| UnitedHealthcare | UnitedHealthcare of the River Valley | All | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare of the River Valley Effective October 1, 2026 |
| UnitedHealthcare Community Plan | Texas CHIP | TX | prior auth under conditions | site of care: outpatient | Jul 1, 2024 | Prior 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 Plan | Texas STAR | TX | prior auth under conditions | site of care: outpatient | Jul 1, 2024 | Prior 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 Plan | Texas STAR Kids | TX | prior auth under conditions | site of care: outpatient | Jul 1, 2024 | Prior 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 Plan | Texas STAR+PLUS | TX | prior auth under conditions | site of care: outpatient | Jul 1, 2024 | Prior 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 Plan | UnitedHealthcare Community Plan of Hawaii (QUEST Integration) | HI | prior auth under conditions | site of care: outpatient | Oct 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Hawaii Effective October 1, 2026 |
| UnitedHealthcare Community Plan | UnitedHealthcare Community Plan of Kentucky | KY | prior auth under conditions | site of care: outpatient | Jul 1, 2026 | Prior authorization requirements for UnitedHealthcare Community Plan of Kentucky Effective July 1, 2026 |
J9074 appears in 37 coverage policies from Aetna, BlueCross BlueShield of South Carolina, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Adalimumab (0655) Anakinra (Kineret), Rinvoq, Otezla and Xeljanz, Clindamycin, Metronidazole, Rifampicin, Sulfasalazine, Leflunomide - | listed, no stance | Jul 13, 2026 | payer document |
| Aetna | Anifrolumab-fnia (Saphnelo) (0997) | listed, no stance | Jun 5, 2026 | payer document |
| Aetna | Antiemetic Therapy (0724) | listed, no stance | Jul 17, 2026 | payer document |
| Aetna | Belimumab (Benlysta) (0818) | listed, no stance | Jun 10, 2026 | payer document |
| Aetna | Brentuximab Vedotin (Adcetris) (0823) | listed, no stance | Sep 24, 2026 | payer document |
| Aetna | Carfilzomib (Kyprolis) (0845) | listed, no stance | Mar 2, 2026 | payer document |
| Aetna | Clofarabine (0867) | listed, no stance | Dec 24, 2025 | payer document |
| Aetna | Daratumumab (Darzalex) and Daratumumab and Hyaluronidase-fihj (Darzalex Faspro) (0904) Pomalidomide, lenalidomide, thalidomide, Selinexor, Venetoclax | listed, no stance | Jun 8, 2026 | payer document |
| Aetna | Golimumab (Simponi and Simponi Aria) (0790) | listed, no stance | Jul 31, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Hodgkin's Disease (0495) | listed, no stance (range J9000-J9999) | Jul 2, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Multiple Myeloma (0497) | listed, no stance (range J9000-J9999) | Aug 5, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Selected Childhood Solid Tumors (0496) | listed, no stance (range J9000-J9999) | Aug 6, 2026 | payer document |
| Aetna | Hematopoietic Cell Transplantation for Thalassemia Major and Sickle Cell Anemia (0626) | listed, no stance (range J9000-J9999) | Sep 18, 2026 | payer document |
| Aetna | Hematopoietic Colony-Stimulating Factors (CSFs) (0055) | listed, no stance | Jul 16, 2026 | payer document |
| Aetna | Infliximab (0341) | listed, no stance | Oct 5, 2026 | payer document |
| Aetna | Infusion Pumps (0161) | covered if criteria are met (range J9000-J9999) | Mar 31, 2026 | payer document |
| Aetna | Injectable Medications (0020) | listed, no stance (range J9000-J9999) | Mar 5, 2026 | payer document |
| Aetna | Inotuzumab Ozogamicin (Besponsa) (0919) | listed, no stance | Jan 27, 2026 | payer document |
| Aetna | Margetuximab-cmkb (Margenza) (0985) | listed, no stance (range J9000-J9999) | May 27, 2026 | payer document |
| Aetna | Mogamulizumab-kpkc (Poteligeo) (0940) | listed, no stance | Apr 28, 2026 | payer document |
| Aetna | Negative Pressure Wound Therapy (0334) | listed, no stance (range J9000-J9999) | Jun 8, 2026 | payer document |
| Aetna | Obinutuzumab (Gazyva) (0877) | listed, no stance | Jun 5, 2026 | payer document |
| Aetna | Pertuzumab Products (0973) | listed, no stance (range J9000-J9999) | Apr 27, 2026 | payer document |
| Aetna | Pharmacogenetic and Pharmacodynamic Testing (0715) | listed, no stance | Oct 8, 2026 | payer document |
| Aetna | Phototherapy and Photochemotherapy (PUVA) for Skin Conditions (0205) | listed, no stance (range J9000-J9999) | May 18, 2026 | payer document |
| Aetna | Polatuzumab Vedotin-piiq (Polivy) (0955) | listed, no stance | Sep 17, 2026 | payer document |
| Aetna | Revakinagene Taroretcel-lwey (Encelto) (1079) | listed, no stance (range J8501-J9999) | Oct 5, 2026 | payer document |
| Aetna | Rituximab (0314) | listed, no stance | Sep 15, 2026 | payer document |
| Aetna | Temsirolimus (Torisel) (0873) | listed, no stance | Oct 8, 2026 | payer document |
| Aetna | Tumor Chemoresistance Assays (0758) | listed, no stance (range J9000-J9999) | Dec 2, 2025 | payer document |
| Aetna | Tumor Chemosensitivity Assays (0245) | listed, no stance (range J9000-J9999) | Apr 13, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Breast Cancer (CAM 80127) | listed, no stance (range J9000-J9999) | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Cell Transplantation for Miscellaneous Solid Tumors in Adults (CAM 80124) | unproven / investigational (range J9000-J9999) | Jul 1, 2026 | payer document |
| BlueCross BlueShield of South Carolina | Hematopoietic Stem-Cell Transplantation for Plasma Cell Dyscrasias, Including Multiple Myeloma and POEMS Syndrome (CAM 80117) | listed, no stance (range J9000-J9999) | Jan 1, 2026 | payer document |
| UnitedHealthcare | Oncology Medication Clinical Coverage (CS2026D0030AR) | listed, no stance | Sep 1, 2026 | payer document |
| UnitedHealthcare | Oncology Medication Clinical Coverage (for Ohio Only) (CSOH2026D0030.F) | listed, no stance | Jun 1, 2026 | payer document |
| UnitedHealthcare | Oncology Medication Clinical Coverage (for Pennsylvania Only) (CSPA2026D0030II) | listed, no stance | Jul 1, 2026 | payer document |
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.