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BCBS TennesseeCommercial · Prior Auth · Medical Policy · TN · Oncology, Urology, OB-GYN +5 moreHigh impact

Leuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)

Act
by Nov 15, 2026
Effective date
Dec 1, 2026
Identified
Sep 10, 2026

Summary

BlueCross BlueShield of Tennessee is establishing a new medical policy for Leuprolide Acetate Depot (Lupron Depot and Lutrate Depot) covering four FDA-approved indications: advanced prostate cancer, ovarian cancer (malignant sex cord-stromal tumors), breast cancer (premenopausal with hormone-receptor positive status), and gender dysphoria. All covered uses require prior authorization with specific approval criteria, and the policy includes detailed requirements for gender dysphoria treatment involving age restrictions, provider specialization, and documented informed consent. This policy will supersede any existing guidance effective December 1, 2026.

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What to do

by Nov 15, 2026 · 8 steps
01Billing and prior authorization teams must implement this new Leuprolide Acetate policy in the BCBS Tennessee billing system and prior auth software.
02Update prior auth requirements to mandate documentation of: (1) diagnosis confirmation for prostate cancer, ovarian cancer, or breast cancer; (2) hormone receptor (HR) positive status for breast cancer; (3) gender dysphoria diagnosis with specialized provider consultation and mental health collaboration for members under 18; (4) Tanner stage documentation for gender dysphoria claims; (5) proof of informed consent regarding fertility preservation and side effects.
03Configure system to auto-approve 12-month authorizations for initial treatment and continuation of therapy when clinical benefit is documented (e.g., serum testosterone <50 ng/dL for prostate cancer).
04For breast cancer, limit total authorization to 5 years maximum.
05Flag any gender dysphoria claims for members under 18 for manual review to verify compliance with state regulatory guidelines and age restrictions.
06Update encounter forms and prior auth checklists to capture all required documentation.
07Claims without proper prior auth or missing required documentation will be denied.
08Train all billing staff and providers on new requirements before December 1, 2026.

Codes mentioned

J9217J9218J9219J9226

Original notice

Leuprolide Acetate Depot Suspension [Lupron Depot (1 month) 7.5mg, Lupron Depot (3 month) 22.5mg, Lupron Depot (4-Month) 30 mg, Lupron Depot (6-Month) 45 mg]; Leuprolide acetate depot (3-month 22.5 mg); Lutrate Depot® (3-month 22.5 mg)
bcbst.com · Always check the source before changing claims.
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Related changes

See all BCBS Tennessee changes →
Leuprolide Acetate Depot Suspension (Lupron Depot-Ped®)MediumEffective Dec 1, 2026 · Medical PolicyLeuprolide Acetate Depot Suspension (Lupron Depot-Ped®)MediumEffective Sep 30, 2026 · Medical PolicyBrowse every BCBS Tennessee change in the policy list

Related policy hubs

BCBS Tennessee policiesTN policy changesOncologyUrologyOB-GYNEndocrinologyPediatricsPsychiatryFamily MedicineInternal MedicineCode J9217Code J9218Code J9219Code J9226

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