NEW PAD Service Authorization Requirements
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Notifies Alaska Medicaid providers that specific physician-administered drug (PAD) HCPCS codes and an HCPCS+NDC combination will require prior service authorization for dates of service on or after 2026-05-11. Affects all provider types billing these codes to Alaska Medicaid.
Effective dates of service on or after 5/11/2026 certain HCPCS codes for intravenous immunoglobulins will require service authorization.
The HCPCS J3490 combined with NDC 25357-0024-01 (Epoxia) will require service authorization effective 5/11/2026.
Service Authorization Criteria
Service Authorization Criteria (administrative)
Authorization requirement applies for dates of service on or after 5/11/2026 for the listed codes:
PAD HCPCS and NDC Codes Requiring Authorization
| J1459 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1552 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1554 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1556 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1557 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1559 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1561 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1568 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1569 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
| J1572 | HCPCS code listed for intravenous immunoglobulin requiring authorization |
Provider Prior Authorization Requirements
PAD Prior Authorization required for listed HCPCS and J3490+NDC (Epoxia)
Service authorization (PAD prior authorization) is required for the listed HCPCS codes for intravenous immunoglobulins and for J3490 when billed with NDC 25357-0024-01 (Epoxia) for dates of service on or after 5/11/2026. Providers must complete the Physician Administered Drug Prior Authorization form to request authorization prior to billing these services. Failure to obtain required service authorization may result in claim denials or nonpayment.
- Affected HCPCS codes: J1459, J1552, J1554, J1556, J1557, J1559, J1561, J1568, J1569, J1572, J1576, J1575, J1566, J1599, J1551, J1555, J1558.
- Affected HCPCS+NDC combination: J3490 billed with NDC 25357-0024-01 (Epoxia).
- Effective date for authorization requirement: dates of service on or after 5/11/2026.
- Use the Physician Administered Drug Prior Authorization form to submit authorization requests.
Key Forms and Definitions
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