Is Tivdak covered by Medicare?

Yes. Tivdak (J9273) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point.

What diagnoses are covered for Tivdak (J9273)?

Medicare does not publish a drug-specific covered-diagnosis list for J9273. The 5 ICD-10 codes on this page are the FDA-approved indications — the labeled uses Medicare will generally pay for under medical necessity. Off-label uses may be covered if supported by an approved compendium.

Which Medicare policy covers Tivdak?

No drug-specific LCD or Billing & Coding Article exists for Tivdak. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).

Why was my Tivdak claim denied as not medically necessary?

The most common cause is a diagnosis the MAC doesn't consider medically necessary for J9273. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.

Tivdak (J9273) Medicare Coverage & FDA Indications

Page reviewed Jun 29, 2026 · from FDA-approved labeling (Drugs@FDA) — no drug-specific Medicare LCD

Quick answer

Medicare benefit

Part B (physician-administered)

FDA-indicated diagnoses

5 ICD-10 codes

Governing policy

FDA indications (no LCD)

Contractor (MAC)

Per medical necessity

Source

FDA labeling

Page reviewed

Jun 29, 2026

HCPCS codes covered:
J9273

No drug-specific Medicare coverage article exists for Tivdak. Coverage is decided per medical necessity by your MAC. The FDA-approved indications below are the labeled uses Medicare generally pays for; an off-label use may be covered if supported by an approved compendium. Find your MAC by state →

What Medicare pays for Tivdak (2026 Q2)

Once a claim carries a covered diagnosis, Medicare Part B reimburses the drug at the ASP + 6% payment limit. Current allowed amounts per billing unit:

HCPCS	Description	Per unit	Allowed (ASP + 6%)
J9273	Inj tisotu vedotin-tftv, 1mg	1 mg	$196.121

Source: CMS ASP Drug Pricing File, 2026 Q2. Payment = ASP + 6% per unit; multiply by units billed (watch JZ/JW wastage). Your patient's share is typically 20% after the deductible. Estimate the full cost & patient out-of-pocket →

Tivdak is a physician-administered biologic billed under Medicare Part B (not the Part D pharmacy benefit). Under Part B, Medicare pays the practice for the drug (HCPCS J9273) plus its administration — but only when the claim's diagnosis (ICD-10) code supports medical necessity. Each MAC publishes the specific covered diagnoses in a Billing & Coding Article; a claim with a diagnosis outside that list is typically denied as not medically necessary (CO-50).

Covered ICD-10 diagnoses for Tivdak

The 5 ICD-10 codes below are the FDA-approved indications for J9273 — the labeled uses Medicare generally pays for under medical necessity — grouped by condition. Use the filter to find a specific code or condition.

Cervical Cancer — 4 diagnoses (applies to J9273)

Neoplasms (4)

ICD-10	Covered diagnosis
C53.0	Malignant neoplasm of endocervix
C53.1	Malignant neoplasm of exocervix
C53.8	Malignant neoplasm of overlapping sites of cervix uteri
C53.9	Malignant neoplasm of cervix uteri, unspecified

Encounter — 1 diagnoses (applies to J9273)

Factors influencing health status (1)

ICD-10	Covered diagnosis
Z51.11	Encounter for antineoplastic chemotherapy

How to use this list when billing

Put a medically necessary, FDA-indicated diagnosis from the list above on the claim line with J9273, match the correct product code and units (check JZ/JW wastage), and document medical necessity. Because there's no drug-specific LCD, coverage is judged per medical necessity by your MAC; an off-label use can still be covered if supported by an approved drug compendium.

LCD vs. Billing & Coding Article vs. NCD

An LCD (Local Coverage Determination) is a MAC's policy on whether a service is reasonable and necessary in its region, and its companion Billing & Coding Article holds the covered ICD-10 and HCPCS code lists. A NCD (National Coverage Determination), where one exists, applies nationwide. Tivdak has no drug-specific LCD or Article, so there is no published covered-code list — it's covered under the general Part B drug benefit per medical necessity, and the FDA-approved indications above are the practical starting point.

Common Tivdak denial reasons

What you see	Why	Fix
CO-50 — not medically necessary	Diagnosis the MAC doesn’t accept as medically necessary	Bill a medically necessary FDA-indicated diagnosis from the list above; document necessity (compendium cite for off-label)
Diagnosis/units mismatch	Right dx but wrong product code or unit count	Match the J/Q code and units to the drug actually given (check JZ/JW wastage)
Off-label denial	Indication isn't FDA-labeled and isn't compendium-supported	Cite an approved compendium (e.g. DrugDex/NCCN) or appeal with literature
Self-administered (SAD) denial	Drug is on your MAC's self-administered exclusion list	Check the SAD list — it may be Part D, not Part B

Frequently asked questions

Is Tivdak covered by Medicare?: Yes. Tivdak (J9273) is covered under Medicare Part B as a physician-administered drug when billed for a medically necessary indication. There is no drug-specific Local Coverage Determination (LCD) for it, so coverage is determined per medical necessity by your MAC; the FDA-approved indications below are the starting point.
What diagnoses are covered for Tivdak (J9273)?: Medicare does not publish a drug-specific covered-diagnosis list for J9273. The 5 ICD-10 codes on this page are the FDA-approved indications — the labeled uses Medicare will generally pay for under medical necessity. Off-label uses may be covered if supported by an approved compendium.
Which Medicare policy covers Tivdak?: No drug-specific LCD or Billing & Coding Article exists for Tivdak. It's covered under the general Medicare Part B drug benefit per medical necessity, as judged by your Medicare Administrative Contractor (MAC).
Why was my Tivdak claim denied as not medically necessary?: The most common cause is a diagnosis the MAC doesn't consider medically necessary for J9273. Bill a covered/FDA-approved indication from the list below, document medical necessity, and confirm any local guidance with your MAC.

Related references

Covered is only half the answer.

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Source & verification

Source: FDA-approved indications (Drugs@FDA labeling) mapped to ICD-10-CM. No drug-specific Medicare LCD/Article exists for Tivdak — Part B coverage is determined per medical necessity by your MAC.
CMS article last revised: n/a — the most recent revision CMS has published for this article.
Page last reviewed by CareCost: Jun 29, 2026 (coverage data retrieved 2026-06-28; we re-verify against CMS quarterly).
Code licensing: ICD-10-CM codes are public domain (CMS/CDC). CPT® codes are AMA-copyrighted and are intentionally not listed here — see the administration-code reference for those.
Not advice: This is general billing reference, not legal or billing advice. Always verify against the LCD/Article that applies to your MAC and patient.
How we build this: Compiled programmatically from the CMS Coverage API and reviewed by the CareCost Estimate editorial team against the source article. See our methodology and editorial policy.
Spotted an error?: Email editorial@carecostestimate.com.