J9187 Inj, etoposide, 1 mg

Injection, etoposide, 1 mg

Medicare pricing for J9187

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

J9187 payment limit: $0.094 per 1 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%. Note: Added October 2026.

NDCs that bill under J9187 (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 J9187

4 of 4 payer prior-auth lists that name J9187 require prior authorization or set conditions: Cigna, HealthSpring.

PayerPlanStatePrior authConditionsSinceSource
CignaACA/IFPAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2026Master Precertification List (For Health Care Providers)
CignaBasic StandardAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2026Master Precertification List (For Health Care Providers)
CignaComplete/PHS+/PreferredAllprior auth requiredMay be delegated to eviCore for some clientsOct 1, 2026Master Precertification List (For Health Care Providers)
HealthSpringMedicare AdvantageAllprior auth requiredOct 1, 20262026 Q4 Prior Authorization List

Payer coverage policies that name J9187

J9187 appears in 16 coverage policies from Aetna, BlueCross BlueShield of South Carolina.

PayerPolicyRole in policyReviewedDocument
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
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
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
AetnaRevakinagene Taroretcel-lwey (Encelto) (1079)listed, no stance (range J8501-J9999)Oct 5, 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

Recent prior-auth changes

  • Oct 1, 2026: PA added, HealthSpring

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.