CommercialPrior AuthMedium impact
Zoladex (goserelin)
Blue Cross & Blue Shield of Mississippi·MS · Oncology, Urology, OB-GYN·Medical Policy
We identified it
Jun 20, 2026
Summary
BCBS Mississippi requires prior authorization for Zoladex (goserelin) with specific medical necessity criteria for breast cancer, prostate cancer, endometriosis, and endometrial thinning. The policy establishes strict approval criteria including age requirements, diagnosis-specific conditions, and treatment duration limits.
Action Required
Immediately: Billing team must obtain prior authorization for all Zoladex (goserelin) prescriptions before administration. Update billing system to flag HCPCS codes J9202 and S9560 as requiring prior auth. Providers must document specific medical necessity criteria including patient age 18+, appropriate diagnosis (advanced breast cancer, prostate cancer, endometriosis, or dysfunctional uterine bleeding), and meet all condition-specific requirements outlined in policy. Claims will be denied without proper prior authorization.