CSHCN Services Program 2010 > Physician > Benefits, Limitations, and Authorization Requirements

    
 

30.2.24.9 Leuprolide Acetate Injection

Procedure code J9217 is allowed for use in monthly, 3-month, 4-month, and 6-month doses.

Providers must bill

Dose Period
Dose Quantity
Quantity Billed
Limitation

Monthly

7.5 mg

1

Once per month

3-month

22.5 mg

3

Once every 3 months

4-month

30 mg

4

Once every 4 months

6-month

45 mg

6

Once every 6 months

the following dosage increments:

Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.
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