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​Billing guidelines for leuprolide acetate (Lupron Depot® and Eligard®)

January 6, 2017

Effective March 14, 2017, changes will apply to providers who bill for leuprolide acetate (Lupron Depot and Eligard).

Coding updates

The following coding guidelines will apply when billing for leuprolide acetate:

  • J1950 (Injection, leuprolide acetate [for depot suspension], per 3.75 mg) should only be reported with non-oncologic diagnoses. Please also note the following:
    • – Reporting breast, ovarian, or prostate cancer with J1950 will be considered not medically necessary and, therefore, not covered.
    • – Reporting any other diagnosis with J1950 will be considered experimental/investigational and, therefore, not covered.
  • J9217 (Leuprolide acetate [for depot suspension], 7.5 mg) will be covered when reported for all indications (oncologic and non-oncologic) based on the medical necessity criteria outlined in our medical policies.

Medical necessity criteria

According to Independence's definition of medical necessity, a service cannot be more costly than an alternative service that is at least as likely to produce equivalent therapeutic or diagnostic results for the treatment of an individual's illness.

Although Lupron Depot has been approved by the U.S. Food and Drug Administration (FDA) for prostate cancer and Compendia supports the use of Lupron Depot for breast and ovarian cancers, Independence considers Eligard to be a lower-cost alternative for treatment of oncologic and non-oncologic diagnoses with leuprolide acetate.

For more information

Independence has created the following medical policies, which are currently posted as Notifications and will become effective on March 14, 2017:

  • Commercial: #08.01.33: Gonadotropin-Releasing Hormone Agonist (Eligard?, Lupron Depot?),
  • Medicare Advantage: #MA08.083: Gonadotropin-Releasing Hormone Agonist (Eligard?, Lupron Depot?)

To view the Notifications for these policies, visit our Medical Policy Portal and select Accept and Go to Medical Policy Online. Then select Commercial or Medicare Advantage under Active Notifications.


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