J9255 Inj, methotrexate (accord)

Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg

Medicare pricing for J9255

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J9255

15 of 19 payer prior-auth lists that name J9255 require prior authorization or set conditions: Blue Cross Blue Shield of Arizona (AZ Blue), HealthSpring, Molina Healthcare of California, Molina Healthcare of Illinois, Rocky Mountain Health Plans, 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 conditionseviCore-delegated groups onlySep 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 requiredSep 1, 2026State of Arizona Group Prior Authorization Requirements Code List (09/01/2026)
HealthSpringMedicare AdvantageAllprior auth requiredJan 1, 20252026 Q4 Prior Authorization List
Molina Healthcare of CaliforniaMedicaidCAprior auth requiredApr 1, 2026Medicaid Prior Auth (PA) Code Matrix (California), effective Q2 2026
Molina Healthcare of IllinoisMedicaidILprior auth requiredJan 1, 2024Molina Healthcare of Illinois Codification Grid Q3 2026
Rocky Mountain Health PlansRocky Mountain Health Plans CHP+COprior auth requiredOct 1, 2026Rocky Mountain Children’s Health Plan - prior authorization Effective October 1, 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: outpatientJan 1, 2024Prior 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: outpatientJan 1, 2024Prior 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: outpatientJan 1, 2024Prior 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: outpatientJan 1, 2024Prior 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 J9255

J9255 appears in 45 coverage policies from Aetna, BlueCross BlueShield of South Carolina, Centene.

PayerPolicyRole in policyReviewedDocument
AetnaAbatacept (Orencia) (0720)
Rinvoq, Xeljanz, Otezla, Ruxolitinib, Hydroxychloroquine, Sulfasalazine		listed, no stanceJul 1, 2026payer document
AetnaAdalimumab (0655)
Anakinra (Kineret), Rinvoq, Otezla and Xeljanz, Clindamycin, Metronidazole, Rifampicin, Sulfasalazine, Leflunomide -		listed, no stanceJul 13, 2026payer document
AetnaAnifrolumab-fnia (Saphnelo) (0997)listed, no stanceJun 5, 2026payer document
AetnaAntiemetic Therapy (0724)listed, no stanceJul 17, 2026payer document
AetnaCertolizumab Pegol (Cimzia) (0761)listed, no stanceJul 1, 2026payer document
AetnaEtanercept (0315)listed, no stanceJul 8, 2026payer document
AetnaGemcitabine (0958)listed, no stanceJul 17, 2026payer document
AetnaGolimumab (Simponi and Simponi Aria) (0790)listed, no stanceJul 31, 2026payer document
AetnaGuselkumab (Tremfya) (1011)listed, no stanceJun 29, 2026payer 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
AetnaInebilizumab-cdon (Uplizna) (0975)listed, no stanceAug 11, 2026payer document
AetnaInfliximab (0341)listed, no stanceOct 5, 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
AetnaInotuzumab Ozogamicin (Besponsa) (0919)listed, no stanceJan 27, 2026payer document
AetnaLevoleucovorin (Khapzory) (0889)listed, no stanceDec 4, 2025payer document
AetnaMargetuximab-cmkb (Margenza) (0985)listed, no stance (range J9000-J9999)May 27, 2026payer document
AetnaMultiple Sclerosis (0264)
Serum neurofilament, Osteopontin, Clemastine fumarate, Intravesical vanilloids, cannabis and cannabinoids		not covered (range J9255-J9260)Sep 10, 2026payer document
AetnaNegative Pressure Wound Therapy (0334)listed, no stance (range J9000-J9999)Jun 8, 2026payer document
AetnaNipocalimab-aahu (Imaavy) (1083)listed, no stanceAug 11, 2026payer document
AetnaNon-myeloablative Hematopoietic Cell Transplantation (Mini-Allograft / Reduced Intensity Conditioning Transplant) (0634)listed, no stanceSep 25, 2026payer document
AetnaPalifermin (Kepivance) (0851)listed, no stanceDec 22, 2025payer document
AetnaPertuzumab Products (0973)listed, no stance (range J9000-J9999)Apr 27, 2026payer document
AetnaPharmacogenetic and Pharmacodynamic Testing (0715)listed, no stanceOct 8, 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
AetnaRisankizumab-rzaa (Skyrizi) (1009)listed, no stanceJul 1, 2026payer document
AetnaRituximab (0314)listed, no stanceSep 15, 2026payer document
AetnaSpesolimab-sbzo (Spevigo) (1013)listed, no stanceApr 2, 2026payer document
AetnaTemozolomide (Temodar) Injection (0876)listed, no stanceJun 3, 2026payer document
AetnaTildrakizumab-asmn (Ilumya) (1012)listed, no stanceJul 1, 2026payer document
AetnaTocilizumab (0799)listed, no stanceJun 30, 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
AetnaUstekinumab (0912)listed, no stanceJul 1, 2026payer document
AetnaVedolizumab (Entyvio) (0885)listed, no stanceJun 30, 2026payer document
AetnaVitamin B-12 Therapy (0536)listed, no stanceAug 20, 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
CenteneMethotrexate (Otrexup, Rasuvo, Xatmep, Reditrex, Jylamvo) Reference Number: CP.PHAR.134 (CP.PHAR.134)covered if criteria are metNov 1, 2025payer document

Recent prior-auth changes

  • Jun 1, 2026: PA added, UnitedHealthcare Community Plan
  • Nov 1, 2025: PA removed, UnitedHealthcare Community Plan

Medicaid fee-for-service

  • IL: $1.74 (practitioner), effective Apr 1, 2026
  • IN: $1.65 (professional, Advanced Practice Nurse (85%), non-facility), effective Jan 1, 2024
  • KY: $0.00 (asc), effective Jan 1, 2026
  • LA: $2.01 (professional), effective Jan 1, 2024
  • OH: $1.84 (provider_administered_drugs), effective Jan 1, 2024
  • OK: $2.01 (physician, non-facility), effective Jul 1, 2026
  • VT: $0.00 (outpatient_hospital_opps), effective Feb 1, 2026
  • WA: $1.85 (professional_administered_drugs), effective Jul 1, 2026
  • WY: $0.00 (outpatient_hospital_apc, Children's Hospitals), 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.