Lupron Depot (leuprolide acetate) — HCPCS J1950

Lupron Depot formulations — pick the right kit FDA verified May 2026

All formulations bill under the same J1950 code, but the unit count varies by mg strength.

Dosing & unit math FDA label 2025

From FDA prescribing information, multiple NDAs (per formulation).

Adult prostate cancer (advanced/palliative)

• 7.5 mg IM every month (most common starter regimen)
• 22.5 mg IM every 3 months
• 30 mg IM every 4 months
• 45 mg IM every 6 months (longest interval; preferred for stable adherent patients)
• Same total annual drug delivery; choice driven by patient preference, adherence, and travel logistics

Adult endometriosis

• 3.75 mg IM every month for up to 6 months continuous
• 11.25 mg IM every 3 months for up to 2 doses (6 months total)
• Add-back therapy (norethindrone 5 mg/day) recommended to mitigate BMD loss
• Retreatment generally discouraged; consider oral GnRH antagonist (elagolix) for chronic management

Adult uterine fibroids (pre-operative)

• 3.75 mg IM every month × 3 months pre-myomectomy/hysterectomy
• 11.25 mg IM × 1 dose (3-month course)
• Concurrent iron supplementation often co-prescribed for anemia correction

Pediatric central precocious puberty (Lupron Depot-PED, ≥2 yr)

• Body weight <25 kg: 7.5 mg IM monthly
• 25–37.5 kg: 11.25 mg IM monthly
• >37.5 kg: 15 mg IM monthly
• Titrate up if LH not adequately suppressed at 4-week stim test
• Discontinue at appropriate age for onset of puberty (per pediatric endocrinology)

Worked example — year-1 billing for prostate cancer (7.5 mg q1mo)

Worked example — year-1 billing for endometriosis (11.25 mg q3mo × 2 doses)

Tumor flare prophylaxis (prostate cancer)

Initial GnRH agonist administration causes a transient surge in testosterone (days 7–14) that can worsen bone pain or cord compression in patients with high tumor burden. NCCN recommends concurrent anti-androgen (bicalutamide 50 mg/day) for the first 2–4 weeks. Firmagon (degarelix, J9155) is a GnRH antagonist alternative with no flare — consider for patients with imminent flare risk.

NDC reference FDA NDC Directory verified May 2026

GnRH analog class comparison Verified May 2026

Five injectable products in the GnRH agonist/antagonist class — each with its own HCPCS code.

Administration codes CPT verified May 2026

Two CPT codes apply, depending on indication. This is the most common Lupron Depot coding error.

Admin code by indication — quick reference Verified May 2026

Modifiers CMS verified May 2026

JZ — required on virtually every claim

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. Lupron Depot is supplied as a single-dose kit (pre-filled syringe + diluent) delivering a fixed depot dose — no partial-dose waste possible. JZ applies to every J1950 claim.

JW — does not apply

JW reports the discarded portion of a single-dose vial. Lupron Depot kits deliver the full kit dose with no waste. Do not bill JW — there is no scenario where JW would be appropriate for J1950. One of JZ or JW must be on every J1950 claim per CMS policy — in practice, this means JZ on every claim.

Modifier 25 — same-day E/M

Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the injection (e.g., quarterly oncology visit + Lupron Depot injection, or interval CPP follow-up + Lupron Depot-PED). Routine pre-injection clinical assessment is bundled into the admin code.

340B modifiers (JG, TB)

For 340B-acquired Lupron Depot, follow your MAC's current 340B modifier policy. Append JG (340B-acquired drug) for hospital outpatient settings or TB per CMS guidance. AbbVie's billing guide does not provide 340B-specific instructions.

ICD-10-CM by indication FY2026 verified May 2026

Indication-specific ICD-10 selection drives the admin CPT choice. Use the most specific code documented.

Site of care & place of service Verified May 2026

Lupron Depot is a clinic-administered single IM injection (~2 minutes of nursing time). Site-of-care steering is less aggressive than for IV biologics, but most commercial plans prefer office settings over HOPD. Pediatric Lupron Depot-PED for CPP is typically administered in pediatric endocrinology offices.

Claim form field mapping AbbVie 2026

CMS-1500 / 837P field mapping for buy-and-bill J1950 claims.

Payer policy snapshot Reviewed May 2026

PA requirements vary materially by indication. Prostate cancer = generally covered; endo/fibroids = often step therapy required.

Step therapy for endometriosis / fibroids

Most commercial payers now require trial of oral GnRH antagonist before approving Lupron Depot for endometriosis or fibroids:

• Endometriosis: elagolix (Orilissa) 150 mg daily for 6 months, then 200 mg BID for 6 months
• Fibroids (heavy menstrual bleeding): relugolix/estradiol/norethindrone (Myfembree) daily × 24 months
• Documented inadequate response, intolerance, or contraindication to oral antagonist required for Lupron Depot approval
• Step therapy waiver if patient has contraindication to oral antagonist (severe hepatic impairment, concurrent CYP3A interaction)

Central precocious puberty PA criteria

• Pediatric endocrinology specialist documentation
• Confirmed central (not peripheral) precocious puberty — suppressed LH/FSH on GnRH stimulation test
• Bone age advancement >1 year beyond chronological age
• Predicted adult height <5th percentile or >2 SD below midparental height
• Age ≥2 years at initiation (FDA label)

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.

Coverage

No NCD specific to leuprolide. Coverage falls under MAC LCDs for hormonal anti-neoplastic drugs (prostate cancer indication) and Part B drug coverage framework (endometriosis, fibroids, CPP). All MACs cover J1950 for FDA-approved on-label indications with appropriate ICD-10 documentation.

Code history

• J1950 — "Leuprolide acetate (for depot suspension), per 3.75 mg" — permanent code
• J9217 — Eligard (separate code for Tolmar's leuprolide SC depot)
• J9218 — (deprecated; previously used for non-depot leuprolide injection)

Patient assistance — AbbVie programs AbbVie verified May 2026

• AbbVie Patient Assistance Foundation: 1-800-441-4900 — free product for uninsured / underinsured patients meeting income requirements
• Lupron Co-Pay Card: commercial copay support for eligible commercially-insured patients (excludes Medicare, Medicaid, federal program patients per federal anti-kickback law)
• myAbbVie Assist: benefits investigation, prior authorization assistance, appeal support
• Foundations: for Medicare patients, refer to PAN, HealthWell, CancerCare, Patient Advocate Foundation — verify open prostate cancer / fibroids / endometriosis funds quarterly
• Phone: AbbVie Patient Assistance 1-800-441-4900
• Web: lupron.com

Common denials & how to fix them

Frequently asked questions

What is the HCPCS code for Lupron Depot?

Lupron Depot (leuprolide acetate IM depot) is billed under HCPCS J1950 — "Leuprolide acetate (for depot suspension), per 3.75 mg." Each 3.75 mg equals one billable unit (NOT 1 mg). Eligard (Tolmar's leuprolide SC depot) is a SEPARATE code — J9217 — and should not be cross-billed.

How many units do I bill for a 7.5 mg Lupron Depot dose?

Bill 2 units of J1950 per 7.5 mg dose (7.5 ÷ 3.75 = 2). For 3.75 mg: 1 unit. For 11.25 mg q3mo: 3 units. For 22.5 mg q3mo: 6 units. For 30 mg q4mo: 8 units. For 45 mg q6mo: 12 units. The unit basis is 3.75 mg per unit — treating it as 1 mg per unit is the most common biller error and under-bills by 73%.

What administration CPT do I use for Lupron Depot?

Indication-dependent. For prostate cancer, use CPT 96402 — "Chemotherapy administration, SC/IM; hormonal anti-neoplastic." For endometriosis, uterine fibroids, or central precocious puberty, use CPT 96372 — "Therapeutic, prophylactic, or diagnostic injection; SC or IM." Submitting 96402 with non-oncology ICD-10 will deny for code incompatibility.

Do I bill JZ or JW for Lupron Depot?

Bill JZ on every Lupron Depot claim. The single-dose kit delivers a fixed depot dose with no partial-dose waste possible — JW does not apply. One of JZ or JW must be on every J1950 claim per CMS's July 2023 single-dose container policy; in practice this means JZ on every claim.

What is the Medicare reimbursement for J1950?

For Q2 2026, the Medicare Part B payment limit for J1950 is $1,765.574 per 3.75 mg unit (ASP + 6%). The standard 7.5 mg monthly prostate cancer dose reimburses at approximately $3,531.15 per injection (2 units); 22.5 mg q3mo at approximately $10,593.44; 45 mg q6mo at approximately $21,186.89. Annualized cost (Medicare ASP+6%) ~$42,374/year for prostate cancer regardless of interval. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.

How does Lupron Depot differ from Eligard?

Both are leuprolide acetate depot formulations, but they are SEPARATE billing codes: Lupron Depot = J1950 (AbbVie, IM injection, 3.75 / 7.5 / 11.25 / 22.5 / 30 / 45 mg formulations across prostate cancer, endometriosis, fibroids, and CPP). Eligard = J9217 (Tolmar, SC injection with Atrigel polymer delivery, 7.5 / 22.5 / 30 / 45 mg, prostate cancer only). Do not cross-bill — either direction triggers wrong-product denial.

Does Lupron Depot require prior authorization?

Often yes for non-oncology indications. Prostate cancer: typically covered without strict PA per Medicare LCDs and most commercial plans (NCCN-aligned). Endometriosis / uterine fibroids: most commercial payers require PA, often with step therapy through oral GnRH antagonists (elagolix [Orilissa] for endometriosis, relugolix [Myfembree] for fibroids) before approving GnRH agonist injection. Central precocious puberty: requires pediatric endocrinology specialist documentation, growth/bone-age workup, and confirmed central (not peripheral) etiology.

What ICD-10 codes apply to Lupron Depot?

Indication-specific. Prostate cancer: C61. Endometriosis: N80.0– N80.9 (anatomic site). Uterine fibroids: D25.0–D25.9 (location). Central precocious puberty: E30.1. Use the most specific code documented in the encounter note.

Why is there a "tumor flare" warning for prostate cancer?

GnRH agonists initially stimulate the pituitary before desensitizing it, causing a transient testosterone surge in the first 7–14 days. In prostate cancer patients with high tumor burden, this can worsen bone pain, urinary obstruction, or cord compression. NCCN recommends concurrent anti-androgen (bicalutamide 50 mg/day) for the first 2–4 weeks. Patients with imminent flare risk should consider Firmagon (degarelix, J9155) — a GnRH antagonist that suppresses LH/FSH immediately with no flare.

Source documents

1. DailyMed — LUPRON DEPOT (leuprolide acetate) Prescribing Information
   FDA-approved label across all formulations (3.75, 7.5, 11.25, 22.5, 30, 45 mg + PED), revised 2025
2. AbbVie Lupron Depot HCP & Patient Site
   Manufacturer dosing, billing, and patient-assistance information
3. CMS — Medicare Part B Drug ASP Pricing File
   Q2 2026 quarterly file, effective April 1 – June 30, 2026
4. SEER CanMED — HCPCS J1950 reference
5. NCCN Guidelines — Prostate Cancer (current version)
   Androgen deprivation therapy recommendations including LHRH agonist + anti-androgen flare prophylaxis
6. AUA Guidelines — Advanced Prostate Cancer
7. ACOG Practice Bulletins — Endometriosis & Uterine Leiomyomas
8. UnitedHealthcare — Oncology Medication & Ob/Gyn Drug Policies
9. Aetna CPB 0501 — Gonadotropin-Releasing Hormone Analog Therapy
10. FDA National Drug Code Directory
11. AbbVie Patient Assistance Foundation
    1-800-441-4900

About this page

We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.

Found an error? Email hello@carecostestimate.com.

Refresh cadence

Reviewer

Change log

• May 2, 2026 — Initial publication. ASP data: Q2 2026. Manufacturer source: AbbVie 2026. FDA label: 2025 revision. All adult formulations (3.75 / 7.5 / 11.25 / 22.5 / 30 / 45 mg) and Lupron Depot-PED (7.5 / 11.25 / 15 mg) covered. GnRH analog class comparison includes Eligard (J9217), Trelstar (J3315), Zoladex (J9202), and Firmagon (J9155).

Methodology

Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Formulation and dosing details are verified against the current FDA prescribing information for each NDC. We do not paraphrase from billing-software vendor blogs.