J1950 prior authorization | Aetna

J1950, (LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Lupron depot (leuprolide acetate) — precertification required for Medicare, is on the Aetna prior authorization list. Not a coverage or referral decision.

Code: J1950
Description: (LHRH) agents: Commercial plans — precertification required for prostate cancer only Medicare plans — precertification required for all diagnoses Lupron depot (leuprolide acetate) — precertification required for Medicare
Source: Participating provider precertification list for Aetna, Pg 28 Original policy

Aetna prior authorization

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