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CommercialCoverageMedium impact

State and School Employees' Health Insurance Plan - Lupron (leuprolide acetate)

Blue Cross & Blue Shield of Mississippi·MS · Endocrinology, OB-GYN, Oncology +2 more·Medical Policy
Effective date
Not stated
We identified it
Jun 20, 2026
Days to comply

Summary

This is a new medical policy for the State and School Employees' Health Insurance Plan covering Lupron (leuprolide acetate) with specific coverage criteria for endometriosis, uterine fibroids, precocious puberty, and prostate cancer. The policy establishes initial approval criteria, limited approval durations (3-6 months), and renewal restrictions for different conditions.

Action Required

Action needed
Immediately: Billing team must ensure prior authorization is obtained through BCBSMS review process before administering Lupron (J1950, J9217, J9218) for State and School Employees' Health Insurance Plan members. Update billing system to flag these codes and verify medical necessity documentation meets specific criteria for each diagnosis. Note that Fensolvi is considered not medically necessary and claims will be denied.

Affected Billing Codes

J1950
J9217
J9218
S9560
C44.501
C44.511
C44.521
C44.591
C50.011
C50.012
C50.019
C50.111
C50.112
C50.119
C50.211
C50.212
C50.219
C50.311
C50.312
C50.319
C50.411
C50.412
C50.419
C50.511
C50.512
C50.519
C50.611
C50.612
C50.619
C50.811
C50.812
C50.819
C50.911
C50.912
C50.919
C50.021
C50.022
C50.029
C50.121
C50.122
C50.129
C50.221
C50.222
C50.229
C50.321
C50.322
C50.329
C50.421
C50.422
C50.429
C50.521
C50.522
C50.529
C50.621
C50.622
C50.629
C50.821
C50.822
C50.829
C50.921
C50.922
C50.929
C50.A0
C50.A1
C50.A2