Summary & Overview
HCPCS Level II J8670: Rolapitant, Oral, 1 mg
HCPCS Level II code J8670 identifies oral rolapitant, 1 mg, an antiemetic used to prevent chemotherapy-induced nausea and vomiting. Nationally, accurate coding for supportive oncology drugs like rolapitant matters for clinical continuity, formulary management, and consistent claims processing across payers. This code is relevant to outpatient oncology care, infusion centers, and pharmacy benefit administrations.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage patterns, where available, common billing contexts, and clinical context for rolapitant use. The publication outlines benchmarks for utilization and reimbursement structures where available, summarizes notable policy updates affecting antiemetic drug coding and coverage, and explains how J8670 is applied in outpatient and pharmacy claims.
The summary provides guidance on documentation and billing contexts (service lines and typical sites of service), highlights payer-specific considerations, and points to related service and coding areas to review. Data not available in the input will be clearly noted in relevant sections of the full publication.
Billing Code Overview
HCPCS Level II code J8670 represents rolapitant, oral, 1 mg. This code denotes the drug product for oral administration of rolapitant, an antiemetic medication used to prevent chemotherapy-induced nausea and vomiting.
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Service type: Oral medication administration (pharmacologic therapy)
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Typical site of service: Outpatient settings where oral antichemotherapy supportive medications are provided, including oncology clinics, infusion centers, and outpatient pharmacies.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 58-year-old oncology patient receiving moderately to highly emetogenic chemotherapy for solid tumor management is prescribed oral rolapitant for prevention of delayed chemotherapy-induced nausea and vomiting (CINV). The medication J8670 (Rolapitant, oral, 1 mg) is administered as part of an antiemetic regimen typically given on the day of chemotherapy and continued per protocol for prevention of delayed emesis. The usual clinical workflow: the oncology clinician documents the indication and selects the antiemetic regimen in the chemotherapy order set; pharmacy dispenses J8670 and records lot and quantity in the medication administration record; nursing or the patient receives oral dose on day 1 (often 1–2 hours prior to chemotherapy) with counseling on adverse effects and drug interactions; follow-up evaluation occurs at next clinic visit or via telephone to assess nausea control and adverse events. Typical sites of service include outpatient oncology infusion centers, hospital outpatient departments, and ambulatory clinics where chemotherapy and supportive medications are coordinated. Patient scenarios include adults receiving multi-day or single-day emetogenic chemotherapy where a NK1 receptor antagonist is indicated for delayed-phase CINV prophylaxis.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Routine service |