Lupron Depot and the leuprolide acetate GnRH-agonist family: J1950, J9217, J1951, J1952, J9202, J3315

Leuprolide acetate products: the gynecology kits and the wider GnRH-agonist family

Lupron Depot bills two different HCPCS codes depending on the strength: the 3.75 mg and 11.25 mg gynecology kits this page covers bill J1950 at 1 unit per 3.75 mg, while the same brand's 7.5–45 mg prostate-cancer strengths bill J9217 at 1 unit per 7.5 mg. Five other products from other manufacturers treat the same GnRH-agonist class under their own codes. Pricing comparison lives in Current Lupron Depot pricing.

Zoladex (J9202) has no CMS Average Sales Price payment limit published for Q4 2026, so no Medicare dollar figure exists to price it against. Confirm the payer's own contracted rate before billing.

J1950 vs. J9217: same brand, different product

J1950 bills per 3.75 mg, covering the 3.75 mg 1-month and 11.25 mg 3-month kits used for endometriosis and preoperative fibroid anemia, given as a single intramuscular injection and reported with 96372.

J9217 ("per 7.5 mg") covers the 7.5, 22.5, 30 and 45 mg prostate-cancer strengths, reported with 96402, neither the strength nor the indication this page covers. Because the two codes price differently per unit, billing a gynecology dose under J9217 or a prostate dose under J1950 misstates the claim in both directions, and the two AbbVie assistance programs under J1950 apply to the gynecology kits specifically.

Eligard (J9217)

Tolmar · leuprolide acetate (subcutaneous depot) · bills the same code as Lupron Depot's prostate-cancer strengths, not J1950. Not part of this page's gynecology scope.

Fensolvi (J1951)

Tolmar · leuprolide acetate, pediatric formulation · its own HCPCS code, distinct from both J1950 and J9217. No record in this cluster's patient-assistance data.

Camcevi (J1952)

Accord BioPharma · leuprolide mesylate, a different salt form than Lupron Depot's acetate · its own HCPCS code. No ASP rate for J1952 is sourced in this reference.

Zoladex (J9202)

TerSera · goserelin acetate, a different GnRH-agonist molecule, delivered as an implant rather than an injection suspension · bills J9202. No CMS ASP payment limit published for Q4 2026. Confirm the payer's contracted rate before billing.

Trelstar (J3315)

Verity · triptorelin pamoate, another distinct GnRH-agonist molecule · bills J3315 at 1 unit per 3.75 mg.

Lupron Depot dosing, workup and co-therapy

Two kits, two schedules, no weight-based math: the variable that matters to a biller isn't the dose, it's the course length the label caps in months.

Co-therapy

Two combinations run alongside leuprolide acetate, for different indications. Norethindrone acetate 5 mg daily (add-back) is labeled for any endometriosis course beyond the initial six months and reduces the bone-density loss that comes with the drug's hypoestrogenic effect. Oral iron runs alongside the fibroid course; several payers require a documented one-month trial of iron alone before approving leuprolide acetate for the anemia it is meant to correct.

Document which combination applies at every visit. An endometriosis retreatment claim without norethindrone acetate on the chart, or a fibroids claim without a documented failed iron trial where the payer requires one, is what a denial or an audit cites.

Pre-treatment workup checklist

• Confirm the patient is not pregnant before the first injection: pregnancy is a contraindication, and non-hormonal contraception is required during treatment.
• Document the indication's prerequisite: for endometriosis, the contraceptive, NSAID or danazol trial most commercial policies ask for; for fibroids, the hemoglobin-documented anemia, the planned surgery, and a one-month iron trial where the payer requires it.
• Baseline bone-density risk factors before any retreatment course is planned.

Course length and retreatment

Lupron Depot's gynecology kits are course-limited by label, not an ongoing chronic therapy: six months maximum for an initial endometriosis course, three months before fibroid surgery. A claim submitted after the labeled course length is a documentation problem to catch before it happens, not a lapsed prior authorization to appeal afterward.

Retreatment is labeled for endometriosis only, and only in combination with norethindrone acetate add-back: a second six-month course, capped at twelve months of lifetime exposure. Commercial payers write similar caps as authorization durations rather than clinical rules: Aetna's is a lifetime maximum of twelve months, BCBS Minnesota and Capital Blue allow one renewal of six months for endometriosis but none for fibroids, and Independence caps both the initial course and any retreatment at six months each.

Fibroid treatment has no labeled retreatment: the course runs up to three months and ends at surgery.

Need the billing units for a patient? Convert dose to J1950 billing units →

Lupron Depot billing reference

HCPCS

J1950: 1 unit per 3.75 mg. The 1-month kit is 1 unit; the 11.25 mg 3-month kit is 3 units on one line.

The prostate-cancer strengths of the same brand bill a different code, J9217, at 1 unit per 7.5 mg, and the two bases do not convert into each other.

NDC

AbbVie labeler 0074. Pad to 11 digits with a leading zero in the appropriate segment for CMS-1500 Box 24A.

Administration

The gynecology kits are given as a single intramuscular injection, not an infusion. Administration bills 96372 alone: with no infusion to extend, no second time-based code applies.

Modifiers

JZ: required when no drug is discarded; the norm on every gynecology-kit claim. JW is not expected here.

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. Each kit is a single-dose dual-chamber syringe, reconstituted at the visit and given whole, so JZ goes on the J1950 line of every claim.

There is no JW scenario on these pages: the kit is not partially dosed.

Modifier 25: same-day E/M. Append modifier 25 to the same-day E/M code only if a significant, separately identifiable evaluation occurred beyond the routine pre-injection check-in, which is bundled into the administration code.

TB: 340B drug pricing. Hospitals that acquire leuprolide acetate through 340B and bill Medicare report the TB modifier, the sole 340B identifier since CMS discontinued JG on January 1, 2025.

Claim form

CMS-1500 / 837P (physician office; POS 11) field map for a J1950 claim.

Calculate units & JZ →

Lupron Depot coverage

• 17 of 20 commercial payer policy sets require prior authorization
• 0 name a preferred leuprolide acetate product
• 150 individual coverage rules exist across those 20 payers: covered indication (38), clinical prerequisite (34), quantity limit (25), prior authorization (20), contraindication exclusion (12), dosing (7), reauthorization (7), continuation of therapy (2), site of care (2), not covered (2) and step-therapy exception (1)
• 2 of 20 carry a site-of-care rule
• 5 of 20 require documentation that another therapy was tried first: a contraceptive, NSAID or danazol trial for endometriosis, or a failed month of iron alone for fibroids, not a competing GnRH-agonist product
• Because Lupron Depot's gynecology kits and its prostate-cancer strengths share a brand but bill different codes (J1950 vs. J9217), verify the diagnosis on file is endometriosis (N80, 20 of 20 payers) or fibroids (D25, 18 of 20 payers), not a prostate-cancer code

ICD-10 codes by indication

The gynecology kits cover two indications, each with one primary code. Use the most specific code the chart supports.

Pregnancy and undiagnosed abnormal uterine bleeding are contraindications, not indications. Do not submit either as the reason for treatment. A prostate-cancer diagnosis (C61) belongs on a J9217 claim for the same brand's prostate strengths, not a J1950 claim for the gynecology kits.

See the Medicare coverage library for the MAC-level ICD-10 ranges by drug; leuprolide acetate does not yet have its own page there.

Check the patient's actual policy: See Lupron Depot coverage by payer →

Current Lupron Depot pricing

Medicare ASP+6%: $1,799.052 / 3.75 mg, which is the whole 3.75 mg dose (1 unit). Add the $15.36 administration allowance for 96372 and the claim totals $1,814.41 before the sequester.

Sequestration reduces Medicare's 80% share by 2%. Commercial plans pay a contracted rate that differs by payer and state.

6 doses over the labeled 6-month course (3.75 mg IM once a month for a 6-month course, the labeled maximum for endometriosis (fibroids: up to 3 months before surgery)) at $1,814.41 per dose — drug plus 96372 administration — total $10,886.47 before the sequester. That is the full 6-month-course drug-plus-administration cost for a patient completing an endometriosis course on schedule, before benefits or assistance.

Look up commercial reimbursement →

Patient cost

The patient's actual responsibility depends on: payer allowed rate · remaining Part B deductible ($283 in 2026) · benefits · − assistance · = patient responsibility. At 18.5% coinsurance on the drug and 20% on the administration after the deductible is met, a Medicare patient's share of the 3.75 mg kit is $335.98 ($332.91 drug plus $3.07 for the injection).

Calculate a Lupron Depot patient estimate →

Copay & financial assistance

Two AbbVie programs exist for Lupron Depot, but always confirm a program covers the gynecology kits specifically before pointing a patient to it. Lupron Depot's prostate-cancer strengths bill a different code (J9217), so a program page written for that product does not apply here.

No foundation fund on file covers endometriosis or fibroids: the funds tied to this brand target prostate, breast and head-and-neck cancer, and all are currently closed. Check current open/closed status before assuming availability; status changes without notice.

See current Lupron Depot assistance programs →

Common Lupron Depot denials & fixes