What insurance policy changes affect HCPCS J9305?

There are 9 tracked policy changes affecting HCPCS J9305, including updates from Humana, UnitedHealthcare, Aetna. Each change may modify coverage criteria, reimbursement rates, or prior-authorization requirements.

Which payers have updated policy for HCPCS J9305?

Payers that have issued tracked updates for HCPCS J9305 include: Humana, UnitedHealthcare, Aetna, Florida Blue, Highmark, Cigna.

How do I get notified when HCPCS J9305 policy changes?

Create a free account at PolicyChanges.app and save a search filtered to HCPCS J9305. You will receive a daily digest email whenever a new policy change references this code.

Why do payers change policies for HCPCS J9305?

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.

J9305 — Injection, pemetrexed, not otherwise specified, 10 mg: Insurance Policy Changes

J9305 Insurance Policy Changes

HCPCS J9305 is officially defined as "Injection, pemetrexed, not otherwise specified, 10 mg." HCPCS J9305 is referenced in 9 tracked payer policy changes from Humana, UnitedHealthcare, and 4 other payers. For billers and coders, staying current on payer-specific coverage criteria, reimbursement rules, and prior-authorization requirements for HCPCS J9305 is critical to clean claim submission. Each entry below links to the full policy analysis with effective dates and action steps.

High impact

Nivolumab products (Opdivo, Opdivo Qvantig) (New)

Humana·Effective Sep 1, 2026

Humana Louisiana Medicaid has established a new prior authorization pharmacy coverage policy for Nivolumab products (Opdivo, Opdivo Qvantig) effective September 1, 2026, covering 17 cancer indications including melanoma, renal cell carcinoma, NSCLC, Hodgkin lymphoma, and others. The policy requires prior authorization for all covered indications with specific clinical criteria and exclusions (including disease progression on prior anti-PD-1/PD-L1 therapy). Initial and renewal approvals are valid for 6 months or as determined through clinical review.

J9305 Insurance Policy Changes

Nivolumab products (Opdivo, Opdivo Qvantig) (New)

Changes to injectable oncology drug coverage are coming

Amivantamab-vmjw (Rybrevant) and Amivantamab and Hyaluronidase-lpuj (Rybrevant Faspro) (CPB 0995, reviewed 2026-08-05)

New Drug Waste Reduction Guideline

Medicare Part B Step Therapy May Updates

Prior Authorization Changes to Oncology-related Codes

Medication Waste (Revised)

Pemetrexed Products (Revised)

Oncology drug dose rounding program: July 7 drug list update