HCPCS Level II J9030: BCG Live Intravesical Instillation, 1 mg
Commercial payers pay $4 on average nationally for this procedure.
HCPCS Level II code J9030 describes administration of BCG live intravesical instillation, 1 mg, a bladder-directed antineoplastic biologic therapy delivered as an intravesical instillation for treatment or prophylaxis of superficial bladder cancer; the service type is intravesical drug instillation and the typical site of service is an outpatient urology or oncology clinic where bladder instillation procedures are performed.
For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only).
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National Reimbursement Benchmarks
National commercial rates for J9030 center on an average BUCA commercial rate of $4.30; that serves as a useful mid-market reference point against payer-specific spreads. Blue Cross Blue Shield shows very tight dispersion with a P75–P25 range of $0.40, and Cigna also tight at $0.00 (no interquartile spread). UnitedHealth Group and Aetna present wider interquartile spreads at $0.40 and $1.70 respectively, indicating more variability in typical contracted rates.
Maximum-to-minimum differences reflect further heterogeneity: Aetna has the largest overall spread between its min and max ($182.30), while Blue Cross Blue Shield and Cigna sit near the lower end of variability. These contrasts highlight that commercial pricing for J9030 can be clustered around BUCA’s $4.30 for some payers but remains highly dispersed for others, particularly Aetna and UnitedHealth Group.