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    v1.0.28
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9299-nivolumab-injection-1mg
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    HCPCS Level II J9299: Injection, nivolumab, 1 mg

    HCPCS Level II code J9299 describes a billed unit for an injection of nivolumab, 1 mg, intended for systemic immunotherapy treatment; the service type is intravenous infusion/injection of an oncology biologic and the typical site of service is an outpatient infusion center or hospital outpatient department where oncology infusions are administered.

    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 pricing centers on a BUCA average commercial rate of $149.70 for J9299, while individual commercial payers cluster at substantially lower medians. Blue Cross Blue Shield and Cigna both show medians near $32–$33, and UnitedHealth Group’s median is $34.90. Aetna displays extreme dispersion driven by outliers, with a mean far above others at $843.90 and a wide spread between its P25 ($16.50) and P75 ($34.00).

    Comparing interquartile dispersion (P75 minus P25), Aetna is the widest with a range of $17.50, indicating greater variability in typical commercial payments. UnitedHealth Group and Blue Cross Blue Shield are tighter, with ranges of $4.70 and $1.20 respectively, while Cigna’s IQR is $5.80 and BUCA’s IQR is $6.70, placing them in a mid-range of dispersion.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 64-year-old patient with metastatic malignant melanoma (C43.9) presents to the outpatient infusion clinic for systemic immunotherapy. The treating medical oncologist (Medical Oncology Physician) prescribes nivolumab administered intravenously. The medication is billed per milligram using the HCPCS Level II code J9299 (Injection, nivolumab, 1 mg). The typical workflow includes pre-infusion nursing assessment, verification of diagnosis and prior authorization, verification of body weight or dosing algorithm, pharmacy preparation of the weight-based dose (multiple milligram units of J9299 combined to reach the ordered dose), time-out and patient identification, infusion via pump or gravity over the recommended infusion time, and post-infusion observation for infusion reactions or immune-related adverse events. Typical site of service is an outpatient hospital infusion center, physician office infusion suite, or ambulatory infusion center. Common clinical scenarios for use include monotherapy for melanoma or other indicated solid tumors (lung, colon, pancreas, prostate when indicated in specific contexts) where checkpoint inhibitor therapy with nivolumab is clinically appropriate and documented.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    J9298

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0003XHematology & Oncology PhysicianAn internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
    207RX0202XMedical Oncology PhysicianAn internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on a…
    207ZP0102XAnatomic Pathology & Clinical Pathology PhysicianA pathologist deals with the causes and nature of disease and contributes to diagnosis, prognosis and treatment through knowledge gained by the labora…
    261QR0200XRadiology Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center
    207ZM0300XMedical Microbiology PhysicianA medical microbiologist is expert in the isolation and identification of microbial agents that cause infectious disease. Viruses, bacteria and fungi,…
    1835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy SpecialistPharmacist Clinician/Clinical Pharmacy Specialist is a pharmacist with additional training and an expanded scope of practice that may include prescrip…
    225CA2500XAssistive Technology Supplier Rehabilitation CounselorRespiratory, Developmental, Rehabilitative and Restorative Service Providers · Rehabilitation Counselor
    2251G0304XGeriatric Physical TherapistA licensed physical therapist, including but not limited to an individual who is a Board Certified Specialist in Geriatric Physical Therapy, who has d…

    Related ICD-10-CM Codes

    27 rows

    ICD-10-CM CodeDescription
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C22.0Liver cell carcinoma
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.11Malignant neoplasm of upper lobe, right bronchus or lung
    C34.12Malignant neoplasm of upper lobe, left bronchus or lung
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C43.9Malignant melanoma of skin, unspecified
    C44.509Unspecified malignant neoplasm of skin of other part of trunk
    C50.912Malignant neoplasm of unspecified site of left female breast

    Showing 1–10 of 27

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Chimeric Antigen Receptor (CAR) T-Cell TherapyColorado Rocky Mountain Health Plans2026-08-01
    Allogeneic Hematopoietic Progenitor Cell TherapyAmbetter Georgia2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Idaho Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for New Jersey Only)UnitedHealthcare2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Ohio Only)UnitedHealthcare2026-08-01
    Reblozyl (luspatercept-aamt) Medical Benefit Drug PolicyUnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J9000-DOXORUBICIN-10MG-INJECTION

    HCPCS J9000: Doxorubicin Hydrochloride Injection, 10 mg

    HCPCS-J9003-LEUPROLIDE-INJECTABLE-CAMCEVI-1MG

    HCPCS Level II J9003: Leuprolide injectable (camcevi etm), 1 mg

    HCPCS-J9010-ALEMTUZUMAB-INJECTION-10MG

    HCPCS Level II J9010: Injection, alemtuzumab, 10 mg

    HCPCS-J9011-DATOPOTAMAB-DERUXTECAN-INJECTION-1MG

    HCPCS J9011: Datopotamab Deruxtecan Injection, 1 mg

    HCPCS-J9015-ALDESLEUKIN-INJECTION-SINGLE-USE-VIAL

    HCPCS Level II J9015: Aldesleukin Injection, Single-Use Vial

    HCPCS-J9017-ARSENIC-TRIOXIDE-INJECTION-1MG

    HCPCS J9017: Arsenic Trioxide Injection, 1 mg

    HCPCS-J9019-ASPARAGINASE-ERWINAZE-INJECTION-1000-IU

    HCPCS Level II J9019: Asparaginase (Erwinaze) Injection, 1,000 IU

    HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

    HCPCS J9020: Asparaginase Injection, 10,000 Units

    HCPCS-J9021-ASPARAGINASE-RYLAZE-INJECTION-0-1-MG

    HCPCS Level II J9021: Injection, asparaginase (Rylaze), 0.1 mg

    HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

    HCPCS J9022: Injection, atezolizumab 10 mg

    Showing 1–10 of 227

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Injection, nivolumab and relatlimab‑rmbw, 3 mg/1 mg
    Related combination product billing code; billed when the combination nivolumab/relatlimab preparation is administered instead of single‑agent nivolumab.