`J9191` Inj fluorouracil (avyxa)10mg

Injection, fluorouracil (avyxa), 10 mg

Medicare coverage: Carrier judgment
Status: active (October 2026 file)

Medicare pricing for J9191

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

J9191 payment limit: $14.84 per 10 MG, effective October 1, 2026 through December 31, 2026, based on 2Q26 ASP data. Coinsurance 20%. Note: Added October 2026.

NDCs that bill under J9191 (CMS ASP NDC-HCPCS crosswalk, October 2026)

83831-0143-01 Favlyxa, Avyxa Pharma, LLC: 25 billing units per package (1 VIAL, SINGLE-DOSE in 1 CARTON / 10 mL in 1 VIAL, SINGLE-DOSE)

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J9191

17 of 17 payer prior-auth lists that name J9191 require prior authorization or set conditions: CarePlus Health Plans, Cigna, Humana.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Cigna	ACA/IFP	All	prior auth required	May be delegated to eviCore for some clients	Oct 1, 2026	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required	May be delegated to eviCore for some clients	Oct 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	Oct 1, 2026	Master Precertification List (For Health Care Providers)
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth required		Jan 1, 2027	Medicare 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
Humana	Humana D-SNP (FL)	FL	prior auth required	New PA requirement	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth required		Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (MI)	MI	prior auth required	New PA requirement	Oct 14, 2026	Humana Dual Integrated (health maintenance organization Dual Eligible Special Needs Plan (HMO D- SNP) Michigan prior authorization and notification list (PAL)
Humana	Humana D-SNP (SC)	SC	prior auth required	New PA requirement	Jul 1, 2026	Humana Dual Integrated South Carolina prior authorization and notification list
Humana	Humana D-SNP (VA)	VA	prior auth required	New PA requirement	Jul 1, 2026	Prior authorization and notification list Humana Dual Fully Integrated H2875-001 (Virginia) Humana Dual Fully Integrated H2875-003 (Virginia)
Humana	Humana Healthy Horizons	KY	prior auth required		Oct 7, 2026	Humana Healthy Horizons in Kentucky Prior Authorization and Notification List
Humana	Humana Healthy Horizons	LA	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Louisiana Prior Authorization and Notification List
Humana	Humana Healthy Horizons	OH	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Ohio prior authorization and notification List
Humana	Humana Healthy Horizons	OK	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Oklahoma Prior Authorization and Notification List
Humana	Humana Healthy Horizons	SC	prior auth required		Oct 14, 2026	Humana Healthy Horizons in South Carolina prior authorization and notification list
Humana	Humana Healthy Horizons	VA	prior auth required		Oct 14, 2026	Humana Healthy Horizons in Virginia professionally administered medication prior authorization and notification list
Humana	Humana MA and D-SNP	All	prior auth required		Jan 1, 2027	Medicare Advantage and Dual Eligible Special Needs Plans prior authorization and notification list Important notes:

Payer coverage policies that name J9191

J9191 appears in 16 coverage policies from Aetna, BlueCross BlueShield of South Carolina.

Payer	Policy	Role in policy	Reviewed	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	Margetuximab-cmkb (Margenza) (0985)	listed, no stance (range J9000-J9999)	May 27, 2026	payer document
Aetna	Negative Pressure Wound Therapy (0334)	listed, no stance (range J9000-J9999)	Jun 8, 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	Revakinagene Taroretcel-lwey (Encelto) (1079)	listed, no stance (range J8501-J9999)	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

Recent prior-auth changes

Oct 14, 2026: PA added, Humana
Oct 14, 2026: PA added, Humana
Oct 14, 2026: PA added, Humana
Oct 14, 2026: PA added, Humana
Oct 14, 2026: PA added, Humana
Oct 7, 2026: PA added, Humana
Oct 1, 2026: PA added, Humana
Jul 1, 2026: PA added, Humana
Jul 1, 2026: PA added, CarePlus Health Plans

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.

J9191 Inj fluorouracil (avyxa)10mg