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PAYER POLICY CHANGES

J9219 Insurance Policy Changes

HCPCS J9219 is officially defined as "Leuprolide acetate implant, 65 mg." HCPCS J9219 is referenced in 10 tracked payer policy changes from BCBS Tennessee, Sentara Health Plans, and 2 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9219 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

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REFERENCE DATA

Payers with rules4
Payers requiring prior auth4
  • CountyCare Health Plan · Effective April 23, 2026

    Prior authorization required

    CountyCare Prior Authorization Look-Up Tool (All Codes)

  • Anthem BCBS · Effective February 11, 2026

    Prior authorization required

    List of items and services that require prior authorization (Medicare)

  • Elevance Health · Effective February 11, 2026

    Prior authorization required

    List of items and services that require prior authorization (Elevance CMS-0057-F list)

FREQUENTLY ASKED QUESTIONS

Does AmeriHealth Caritas require prior authorization for J9219?

AmeriHealth Caritas lists J9219 on AmeriHealth Caritas Louisiana prior authorization service list for medicaid managed plans. Verify with the payer before scheduling.

Does Anthem BCBS require prior authorization for J9219?

Anthem BCBS lists J9219 on List of items and services that require prior authorization (Medicare) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

Does CountyCare Health Plan require prior authorization for J9219?

CountyCare Health Plan lists J9219 on CountyCare Prior Authorization Look-Up Tool (All Codes) for medicaid managed plans (list dated April 23, 2026). Verify with the payer before scheduling.

Does Elevance Health require prior authorization for J9219?

Elevance Health lists J9219 on List of items and services that require prior authorization (Elevance CMS-0057-F list) for medicare advantage plans (list dated February 11, 2026). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS J9219?

There are 10 tracked policy changes affecting HCPCS J9219, including updates from BCBS Tennessee, Sentara Health Plans, Blue Cross & Blue Shield of Mississippi. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J9219?

Payers that have issued tracked updates for HCPCS J9219 include: BCBS Tennessee, Sentara Health Plans, Blue Cross & Blue Shield of Mississippi, Aetna.

How do I get notified when HCPCS J9219 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J9219. You will get an email when new policy changes reference this code: daily or weekly, your choice, on every plan.

Why do payers change policies for HCPCS J9219?

Payers revise policies for individual billing codes to align with updated clinical guidelines, CMS rule changes, fraud and abuse prevention measures, or network cost-management goals. Changes can affect medical necessity criteria, place-of-service restrictions, bundling rules, or whether a code requires prior authorization.

See every payer rule for J9219

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for J9219 in one place.

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RELATED

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