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PAYER POLICY CHANGES

J9262 Insurance Policy Changes

HCPCS J9262 is officially defined as "Injection, omacetaxine mepesuccinate, 0.01 mg." HCPCS J9262 is referenced in 2 tracked payer policy changes from WellCare and Humana. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9262 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 rules11
Payers requiring prior auth11
  • Anthem BCBS · Effective November 1, 2026

    Prior authorization required

    Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial)

  • Elevance Health · Effective February 11, 2026

    Prior authorization required

    List of items and services that require prior authorization (Medicaid GA)

  • Ambetter · Effective December 31, 2025

    Prior authorization required

    Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements

FREQUENTLY ASKED QUESTIONS

Does Ambetter require prior authorization for J9262?

Ambetter lists J9262 on Ambetter from Arizona Complete Health CMS-0057-F prior authorization requirements for exchange plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does AmeriHealth Caritas require prior authorization for J9262?

AmeriHealth Caritas lists J9262 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 J9262?

Anthem BCBS lists J9262 on Anthem Local PPO Precertification/Prior Authorization List (California | Anthem Blue Cross | Commercial) for commercial plans (list dated November 1, 2026). Verify with the payer before scheduling.

Does Arizona Complete Health require prior authorization for J9262?

Arizona Complete Health lists J9262 on Arizona Complete Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

Does CalViva Health require prior authorization for J9262?

CalViva Health lists J9262 on CalViva Health CMS-0057-F prior authorization requirements for medicaid managed plans (list dated December 31, 2025). Verify with the payer before scheduling.

What insurance policy changes affect HCPCS J9262?

There are 2 tracked policy changes affecting HCPCS J9262, including updates from WellCare, Humana. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J9262?

Payers that have issued tracked updates for HCPCS J9262 include: WellCare, Humana.

How do I get notified when HCPCS J9262 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J9262. 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 J9262?

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 J9262

Prior authorization lists, coverage criteria, NCCI edits and Medicare coverage articles for J9262 in one place.

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