`J9999` Chemotherapy drug

Not otherwise classified, antineoplastic drugs

Medicare coverage: Special coverage instructions apply
Status: active (October 2026 file)

Medically Unlikely Edits (effective October 1, 2026)

DME supplier: max 0 units per day (clinical), rationale: Published Contractor Policy

Medicare pricing for J9999

Physician Fee Schedule (CY 2026, RVU26D)

Status E: excluded from the PFS by regulation.

Payer policies and prior authorization for J9999

241 of 241 payer prior-auth lists that name J9999 require prior authorization or set conditions: Aetna, Arkansas Blue Cross and Blue Shield, Blue Cross Blue Shield of Arizona (AZ Blue), Blue Cross and Blue Shield of Illinois, Blue Cross and Blue Shield of Texas, Blue Shield of California Promise Health Plan, CarePlus Health Plans, Cigna, HealthSpring, Humana, Molina Complete Care (Virginia), Molina Healthcare of Arizona, Molina Healthcare of California, Molina Healthcare of Florida, Molina Healthcare of Idaho, Molina Healthcare of Illinois, Molina Healthcare of Iowa, Molina Healthcare of Michigan, Molina Healthcare of Mississippi, Molina Healthcare of Nevada, and others.

Payer	Plan	State	Prior auth	Conditions	Since	Source
Arkansas Blue Cross and Blue Shield	Drugs under the medical benefit (not ASE/PSE or FEP, which use EBRx and Prime)	AR	prior auth under conditions	Unlisted drug code: PA for Amtagvi	Jul 1, 2024	Medical Benefit Pharmacy Prior Approval List
Blue Cross Blue Shield of Arizona (AZ Blue)	AZ Blue-administered Medicare Advantage (M2K)	AZ	prior auth under conditions	Unclassified code: PA only for the listed drugs	Sep 1, 2026	AZ Blue Medicare Advantage Prior Authorization Requirements Code List (Effective 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Federal Employee Program (FEP)	AZ	prior auth under conditions	Unclassified code: PA only for the listed drugs	Sep 1, 2026	Federal Employee Program (FEP) Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Cross Blue Shield of Arizona (AZ Blue)	Standard PA code list (most commercial plans)	AZ	prior auth under conditions	Unclassified code: PA only for the listed drugs	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 under conditions	Unclassified code: PA only for the listed drugs	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	Unclassified code: PA only for the listed drugs	Sep 1, 2026	Teamsters Group Prior Authorization Requirements Code List (Updated 09/01/2026)
Blue Shield of California Promise Health Plan	Promise Health Plan Medi-Cal	CA	prior auth under conditions	Unlisted drug code: PA for the listed drug(s)	Sep 1, 2026	Medi-Cal Prior Authorization List
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Amtagvi	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Avzivi; Step therapy applies	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Revtorpyk	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Sarclisa Escena SC	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Revtorpyk	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Sarclisa Escena SC	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Apr 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	site of care: drug and site of care	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Commercial	All	prior auth under conditions	When billed for Lytenava	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Amtagvi	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Avzivi	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Revtorpyk	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Sarclisa Escena SC	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Poherdy	Apr 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Zimrixby	Oct 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Lytenava	Sep 1, 2026	Participating provider precertification list for Aetna®
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Decnupaz (pivekimab sunirine-pvzy)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Omisirge	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Lytenava	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Lunsumio Velo	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Lantidra	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Evdi (trabectedin)	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Aetna	Medicare Advantage	All	prior auth under conditions	When billed for Poherdy	Aug 25, 2026	Aetna Medicare Part B drug list (partbname.xml)
Cigna	ACA/IFP	All	prior auth required	eviCore Medical Oncology Program for oncology diagnoses; Cigna for other indications; May be delegated to eviCore for some clients	Feb 17, 2017	Master Precertification List (For Health Care Providers)
Cigna	Basic Standard	All	prior auth required	eviCore Medical Oncology Program for oncology diagnoses; Cigna for other indications; May be delegated to eviCore for some clients	Feb 17, 2017	Master Precertification List (For Health Care Providers)
Cigna	Complete/PHS+/Preferred	All	prior auth required	eviCore Medical Oncology Program for oncology diagnoses; Cigna for other indications; May be delegated to eviCore for some clients	Feb 17, 2017	Master Precertification List (For Health Care Providers)
Blue Cross and Blue Shield of Illinois	Blue Cross Community Health Plans (BCCHP), Illinois Medicaid	IL	prior auth required		Jan 1, 2026	Illinois Medicaid Prior Authorization Code List, Effective 10/1/2026
Blue Cross and Blue Shield of Illinois	Blue Cross Community MMAI (Medicare-Medicaid Alignment Initiative)	IL	prior auth required		Jan 1, 2024	Procedure Code List, Effective 1/1/2025
Blue Cross and Blue Shield of Texas	Texas PA exemption (gold card), outpatient, fully insured	TX	prior auth required	Gold-card exemption available	Jul 1, 2026	BCBSTX Outpatient Prior Authorization Exemption Clinical Guidelines (max units, PA exempt date range)
HealthSpring	Medicare Advantage	All	prior auth required		Jan 1, 2025	2026 Q4 Prior Authorization List
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Revtorpyk; NDC 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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Decnupaz	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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Tregzi; NDC 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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Tudriqev; NDC 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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Unituxin; NDC 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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Amtagvi; NDC 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
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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Cligavyx; NDC 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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Sarclisa Escena; NDC 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
CarePlus Health Plans	CarePlus Health Plans	FL	prior auth under conditions	NOC code: PA when billed for Evdi	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 under conditions	NOC code: PA when billed for Cligavyx; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Decnupaz; New PA requirement; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Unituxin; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Tudriqev; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Tregzi; Transplant network review; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Sarclisa Escena; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Revtorpyk; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Evdi; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (FL)	FL	prior auth required		Jan 1, 2027	1 *New prior authorization requirement 787403FL0725 FLHMQSREN Humana Dual Fully Integrated Florida Prior Authorization and Notification List
Humana	Humana D-SNP (FL)	FL	prior auth under conditions	NOC code: PA when billed for Amtagvi; Transplant network review; NDC required	Jul 1, 2026	H1036-280 Humana Fully Integrated Florida prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Evdi; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Revtorpyk; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Sarclisa Escena; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Tregzi; Transplant network review; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Tudriqev; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Amtagvi; Transplant network review; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois 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 (IL)	IL	prior auth under conditions	NOC code: PA when billed for Decnupaz; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Cligavyx; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IL)	IL	prior auth under conditions	NOC code: PA when billed for Unituxin; NDC required	Jan 1, 2027	Humana Dual Fully Integrated Illinois prior authorization and notification list
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Decnupaz; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Cligavyx; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Unituxin; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Tudriqev; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Tregzi; Transplant network review; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Sarclisa Escena; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Revtorpyk; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Evdi; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth under conditions	NOC code: PA when billed for Amtagvi; Transplant network review; NDC required	Jan 1, 2027	Humana PathWays Dual Care (HMO-POS D-SNP) prior authorization and notification list Important notes:
Humana	Humana D-SNP (IN)	IN	prior auth required		Jan 1, 2027	*New prior authorization requirement 814403IN0825 H4939_INHN6Z6EN_C Humana PathWays Dual Care (HMO-POS D-SNP) Indiana Prior Authorization and Notification List
Humana	Humana D-SNP (MI)	MI	prior auth under conditions	NOC code: PA when billed for Unituxin; NDC required	Oct 14, 2026	Humana Dual Integrated (health maintenance organization Dual Eligible Special Needs Plan (HMO D- SNP) Michigan prior authorization and notification list (PAL)

Payer coverage policies that name J9999

J9999 appears in 61 coverage policies from Aetna, Blue Cross & Blue Shield of Mississippi, Blue Cross Blue Shield of Massachusetts, BlueCross BlueShield of South Carolina, Centene, Health Care Service Corporation (BCBS IL, TX, OK, NM, MT), Premera Blue Cross, UnitedHealthcare, Wellmark Blue Cross Blue Shield.

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
Blue Cross & Blue Shield of Mississippi	Injectable Oncology (L.5.01.561)	listed, no stance		payer document
Blue Cross & Blue Shield of Mississippi	Injectable Oncology (S.5.01.561)	listed, no stance		payer document
Blue Cross Blue Shield of Massachusetts	CAR T-Cell Therapy Services for the Treatment of Diffuse Large B-cell Lymphoma (axicabtagene cilleucel or tisagenlecleucel) Prior Authorization Request Form #924	listed, no stance		payer document
BlueCross BlueShield of South Carolina	Adstiladrin (Nadofaragene firadenovec-vncg) (CAM 930)	listed, no stance	May 1, 2026	payer document
BlueCross BlueShield of South Carolina	Amtagvi (lifileucel) (CAM 924)	listed, no stance	Apr 1, 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
BlueCross BlueShield of South Carolina	Nivolumab (Opdivo) (CAM 106)	listed, no stance	Jun 1, 2026	payer document
BlueCross BlueShield of South Carolina	Tecelra (afamitresgene autoleucel) (CAM 931)	listed, no stance	Jun 1, 2026	payer document
Centene	Amivantamab-vmjw (Rybrevant), (CP.PHAR.544) Reviews, Revisions, and Approvals \| Date \| P&T	covered if criteria are met	Aug 1, 2026	payer document
Centene	Bevacizumab (Alymsys, Avastin, Avzivi, Jobevne, Mvasi, Vegzelma, Zirabev) (CP.PHAR.93)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Ciltacabtagene Autoleucel (Carvykti) (CP.PHAR.533) Reviews, Revisions, and Approvals \| Date \| P&T	covered if criteria are met	May 1, 2026	payer document
Centene	Datopotamab Deruxtecan-dlnk (Datroway) (CP.PHAR.715) RT4: Policy created. \| 01.23.25 \| 05.25	covered if criteria are met	May 1, 2026	payer document
Centene	Elranatamab-bcmm (Elrexfio) (CP.PHAR.652) Reviews, Revisions, and Approvals \| Date \| P&T	covered if criteria are met	Nov 1, 2025	payer document
Centene	Lifileucel (Amtagvi) (CP.PHAR.598)	covered if criteria are met	Nov 1, 2025	payer document
Centene	Linvoseltamab-gcpt (Lynozyfic) (CP.PHAR.743)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Pivekimab Sunirine-pvzy (Decnupaz) (CP.PHAR.785)	covered if criteria are met	Aug 1, 2026	payer document
Centene	Ropeginterferon Alfa-2b-njft (BESREMi) (CP.PHAR.570)	covered if criteria are met	Feb 1, 2026	payer document
Centene	Tebentafusp-tebn (Kimmtrak) (CP.PHAR.575) Policy created. \| 02.10.22 \| 05.22	covered if criteria are met	May 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Antineoplaston Cancer Therapy (MED203.002)	listed, no stance	Jan 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Immunoglobulin Therapy (RX504.003)	listed, no stance	Jan 1, 2026	payer document
Health Care Service Corporation (BCBS IL, TX, OK, NM, MT)	Oncology and Supportive Care Medications (RX502.061) Code \| Generic \| Brand	listed, no stance	Jan 1, 2027	payer document
Premera Blue Cross	(effective January 1, 2027) Use of Vascular Endothelial Growth Factor Receptor (VEGF) Inhibitors and Other Angiogenesis Inhibitors in Oncology Treatment (5.01.517)	listed, no stance	Sep 8, 2026	payer document
Premera Blue Cross	Bispecific Antibodies (5.01.650) Page \| 10 of 23 \| ∞	listed, no stance	Aug 11, 2026	payer document
Premera Blue Cross	Denosumab Products (5.01.658)	listed, no stance	Jul 1, 2026	payer document
Premera Blue Cross	Immune Checkpoint Inhibitors (5.01.591) Page \| 36 of 69 \| ∞	listed, no stance	Aug 11, 2026	payer document
Premera Blue Cross	Miscellaneous Oncology Drugs (5.01.540) Page \| 64 of 125 \| ∞	listed, no stance	Oct 1, 2026	payer document
UnitedHealthcare	Denied Drug Codes – Pharmacy Benefit Drugs (for Arizona Only) (CS2026D0990AB)	listed, no stance	Jul 1, 2026	payer document
UnitedHealthcare	Maximum Dosage and Frequency (CS2026D0034AV)	listed, no stance	Aug 1, 2026	payer document
UnitedHealthcare	Maximum Dosage and Frequency (for Ohio Only) (CSOH2026D0034.K) Bilprevda \| denosumab-nxxp \| 120 mg \| C9399 \| 120 HCPCS units	listed, no stance	May 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	Rituximab (Riabni®, Rituxan®, Ruxience® & Truxima®) (for Indiana Only) (CSIND0003.07)	listed, no stance	Aug 1, 2025	payer document
UnitedHealthcare	Rituximab (Riabni®, Rituxan®, Ruxience®, & Truxima®) (2026D0003AO)	listed, no stance	Jan 1, 2026	payer document
UnitedHealthcare	White Blood Cell Colony Stimulating Factors (2026D0061AE)	listed, no stance	Sep 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Anktiva® (nogapendekin alfa inbakicept-pmln) (05.05.49)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Aucatzyl® (obecabtagene autoleucel) (05.05.71)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Bevacizumab (05.04.24)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Bizengri® (zenocutuzumab-zbco) (05.05.80)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Blenrep® (belantamab mafodotin-blmf) (05.06.14)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Inlexzo® (gemcitabine intravesical system) (05.06.19)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Lynozyfic® (linvoseltamab-gcpt) (05.06.01)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Opdualag (nivolumab and relatlimab-rmbw) (05.04.64)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	PiaSkyTM (crovalimab) (05.05.52)	listed, no stance	Oct 1, 2025	payer document
Wellmark Blue Cross Blue Shield	Rytelo™(imetelstat) (05.05.51)	listed, no stance	Jun 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Unloxcyt® (cosibelimab-ipdl) (05.05.79)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Zusduri™ (mitomycin) (05.05.97)	listed, no stance	Aug 1, 2026	payer document
Wellmark Blue Cross Blue Shield	Zynyz (retifanlimab-dlwr) (05.04.99)	listed, no stance	Aug 1, 2026	payer document

Recent prior-auth changes

Jan 1, 2027: PA added, Humana
Oct 1, 2026: PA added, Humana
Aug 1, 2026: PA added, Humana
Jul 1, 2026: conditions changed, CarePlus Health Plans
Jul 1, 2026: conditions changed, Humana
Apr 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois
Jan 26, 2026: PA added, Humana
Jan 1, 2026: conditions changed, Blue Cross and Blue Shield of Illinois
Jan 1, 2026: PA added, Humana
Jan 1, 2026: conditions changed, UnitedHealthcare Community Plan

Medicaid fee-for-service

Prior authorization required or conditional in VT, WA.

KY: $0.00 (asc), effective Jan 1, 2026
OK: $0.00 (physician, non-facility), effective Jul 1, 2026
TX: $0.00 (nurse_practitioner_clinical_nurse_specialist, Nurse Practitioner/Clinical Nurse Specialist, non-facility), effective Jan 1, 1977
VT: $0.00 (outpatient_hospital_opps), effective Feb 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.

J9999 Chemotherapy drug