J9184 Inj gemcitabin (avyxa) 200mgInjection, gemcitabine hydrochloride (avyxa), 200 mg
J9184 payment limit: $403.465 per 200 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%.
83831-0123-01 Avgesmi, Avyxa Pharma, LLC: 5 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 26.3 mL in 1 VIAL, MULTI-DOSE)83831-0124-01 Avgesmi, Avyxa Pharma, LLC: 10 billing units per package (1 VIAL, MULTI-DOSE in 1 CARTON / 52.6 mL in 1 VIAL, MULTI-DOSE)Status E: excluded from the PFS by regulation.
28 of 28 payer prior-auth lists that name J9184 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), Cigna, HealthSpring, Humana, Molina Healthcare of California, Molina Healthcare of Illinois, Molina Healthcare of Michigan, Neighborhood Health Partnership, Oxford Health Plans, Passport by Molina Healthcare (Kentucky), 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 | 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 | place of service 19, 22; site of care: outpatient hospital | Sep 1, 2026 | AZ 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) | AZ | prior auth under conditions | eviCore-delegated groups, all sites | 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) | |
| Blue Cross Blue Shield of Arizona (AZ Blue) | Teamsters group (TYW) | AZ | prior auth under conditions | place of service 19, 22; site of care: outpatient hospital | Sep 1, 2026 | Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026) |
| Cigna | ACA/IFP | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Basic Standard | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2026 | Master Precertification List (For Health Care Providers) |
| Cigna | Complete/PHS+/Preferred | All | prior auth required | May be delegated to eviCore for some clients | Jan 1, 2026 | Master Precertification List (For Health Care Providers) |
| HealthSpring | Medicare Advantage | All | prior auth required | Jan 1, 2025 | 2026 Q4 Prior Authorization List | |
| Humana | Humana Healthy Horizons | OK | prior auth required | Oct 14, 2026 | Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List | |
| Molina Healthcare of California | Medicaid | CA | prior auth required | Apr 1, 2026 | Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026 | |
| Molina Healthcare of Illinois | Medicaid | IL | prior auth required | Jan 1, 2026 | Molina Healthcare of Illinois Codification Grid Q3 2026 | |
| Molina Healthcare of Michigan | Medicare Advantage | MI | prior auth required | Jul 1, 2026 | Molina Healthcare of Michigan PA Matrix 2026-Q3 | |
| Passport by Molina Healthcare (Kentucky) | Medicaid | KY | prior auth required | cancer dx via Evolent | Jan 1, 2026 | Kentucky Medicaid Prior Auth (PA) Code Matrix and Kentucky PA Code Exceptions, effective Q3 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 | Apr 1, 2026 | 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 | Apr 1, 2026 | 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 | Apr 1, 2026 | 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 | Apr 1, 2026 | 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 |
J9184 appears in 39 coverage policies from Aetna, BlueCross BlueShield of South Carolina, UnitedHealthcare.
| Payer | Policy | Role in policy | Reviewed | Document |
|---|---|---|---|---|
| Aetna | Antiemetic Therapy (0724) | listed, no stance | Jul 17, 2026 | payer document |
| Aetna | Bendamustine Products (0875) | listed, no stance | Sep 15, 2026 | payer document |
| Aetna | Brentuximab Vedotin (Adcetris) (0823) | listed, no stance | Sep 24, 2026 | payer document |
| Aetna | Cabazitaxel (Jevtana) (0806) | listed, no stance | Mar 12, 2026 | payer document |
| Aetna | Durvalumab (Imfinzi) (0917) | listed, no stance | Sep 25, 2026 | payer document |
| Aetna | Epcoritamab-bysp (Epkinly) (1034) | listed, no stance | Jul 29, 2026 | payer document |
| Aetna | Gemcitabine (0958) | covered if criteria are met | Jul 17, 2026 | payer document |
| Aetna | Glofitamab-gxbm (Columvi) (1036) | listed, no stance | Sep 14, 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 | 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 | Irinotecan Liposome Injection (Onivyde) (0902) | listed, no stance | Feb 24, 2026 | payer document |
| Aetna | Margetuximab-cmkb (Margenza) (0985) | listed, no stance (range J9000-J9999) | May 27, 2026 | payer document |
| Aetna | Necitumumab (Portrazza) (0898) | listed, no stance | Jul 2, 2026 | payer document |
| Aetna | Negative Pressure Wound Therapy (0334) | listed, no stance (range J9000-J9999) | Jun 8, 2026 | payer document |
| Aetna | Nivolumab Products (Opdivo, Opdivo Qvantig, and Opdualag) (0892) | listed, no stance | Jul 16, 2026 | payer document |
| Aetna | Paclitaxel, Albumin-Bound (0834) | listed, no stance | May 28, 2026 | payer document |
| Aetna | Pembrolizumab Products (Keytruda and Keytruda Qlex) (0890) | listed, no stance | Jul 14, 2026 | payer document |
| Aetna | Pemetrexed Products (0687) | listed, no stance | Jul 17, 2026 | payer document |
| Aetna | Penpulimab-kcqx (1080) | listed, no stance | Apr 15, 2026 | payer document |
| Aetna | Pertuzumab Products (0973) | listed, no stance (range J9000-J9999) | Apr 27, 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 | Ramucirumab (Cyramza) (0883) | listed, no stance | Jun 3, 2026 | payer document |
| Aetna | Revakinagene Taroretcel-lwey (Encelto) (1079) | listed, no stance (range J8501-J9999) | Oct 5, 2026 | payer document |
| Aetna | Sacituzumab Govitecan-hziy (Trodelvy) (0971) | listed, no stance | Apr 24, 2026 | payer document |
| Aetna | Toripalimab-tpzi (Loqtorzi) (1049) | listed, no stance | Oct 5, 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 | Medicare Part B Step Therapy Programs (IAP.001.30) Non-Preferred | listed, no stance | Jul 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 |
Prior authorization required or conditional in VT.
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.