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    v1.0.30
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9011-datopotamab-deruxtecan-injection-1mg
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    HCPCS J9011: Datopotamab Deruxtecan Injection, 1 mg

    HCPCS Level II code J9011 describes the drug product datopotamab deruxtecan-dlnk, 1 mg, reported for administration of this antibody-drug conjugate; the service is a therapeutic drug injection typically provided in an outpatient infusion center or hospital outpatient department where oncology infusions are delivered.

    For related coverage guidance, see recent payer policy updates: Hematology - Adzynma, Tumor Treating Fields for Pancreatic Cancer, Axicabtagene ciloleucel (Yescarta®) coverage.

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    Clinical & Coding Specifications

    Clinical Context

    A patient with advanced or metastatic HER2-low or HER2-positive solid tumor (commonly breast cancer) presents to the oncology infusion center for systemic therapy. The oncologist has prescribed datopotamab deruxtecan-dlnk administered intravenously; billing uses J9011 charged per 1 mg vial. The typical workflow: pre-infusion nursing assessment (vital signs, review of allergies, baseline labs including CBC, CMP, and LFTs), verification of chemotherapy orders and weight-based dosing, pharmacy preparation and verification of J9011 under sterile compounding protocols, and administration via peripheral IV or implanted central venous access by an oncology infusion nurse. Observation for infusion-related reactions and post-infusion monitoring for potential adverse events (eg, neutropenia, interstitial lung disease/pneumonitis, hepatic toxicity) occur in the infusion suite. Documentation includes diagnosis, dose in mg, number of vials, lot number, route, start/stop times, site of service (typically outpatient hospital-based infusion center or physician office infusion suite), and any applicable modifier to reflect unusual circumstances (eg, discontinued service, drug wastage, patient tolerance issues). Typical payors involved include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare for authorization, coverage, and payment adjudication.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, initial, for chemotherapy, up to 1 hourUsed to bill the chemotherapy infusion encounter for administration of J9011 when infusion length fits this descriptor.
    96413Chemotherapy administration, intravenous, infusion technique; each additional hourUsed when the infusion for J9011 extends beyond the initial hour and additional infusion time is billable.
    36415Collection of venous blood by venipuncturePerformed for pre-infusion labs (CBC, CMP, LFTs) required before administering J9011.
    36561Insertion of tunneled central venous catheter, without subcutaneous port or pumpBilled when a tunneled central venous catheter is placed to facilitate repeated infusions of J9011.
    36478Injection of contrast for imaging; not directly related to infusionData not available in the input.
    96417Chemo administration, additional concurrent infusion (each additional drug)Billed when J9011 is administered concurrently with another chemotherapeutic infusion requiring separate infusion lines or pumps.

    Related Modifiers

    7 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    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…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208000000X
    207RC0000X
    163W00000X
    208D00000X
    363L00000X
    207SG0201X
    207VX0000X
    106S00000X

    Related ICD-10-CM Codes

    26 rows

    ICD-10-CM CodeDescription
    C34.10Malignant neoplasm of upper lobe, unspecified bronchus or lung
    C34.90Malignant neoplasm of unspecified part of unspecified bronchus or lung
    C50.011Malignant neoplasm of nipple and areola, right female breast
    C50.012Malignant neoplasm of nipple and areola, left female breast
    C50.112Malignant neoplasm of central portion of left female breast
    C50.121Malignant neoplasm of central portion of right male breast
    C50.122Malignant neoplasm of central portion of left male breast
    C50.212Malignant neoplasm of upper-inner quadrant of left female breast
    C50.311Malignant neoplasm of lower-inner quadrant of right female breast
    C50.312Malignant neoplasm of lower-inner quadrant of left female breast

    Showing 1–10 of 26

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Hematology - AdzynmaCigna2026-10-15
    Tumor Treating Fields for Pancreatic Cancerselect_health2026-10-01
    Axicabtagene ciloleucel (Yescarta®) coverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Kentucky Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Kansas Only)UnitedHealthcare2026-10-01
    Electric Tumor Treatment Field Therapy (for Idaho Only)UnitedHealthcare2026-10-01
    Brexucabtagene autoleucel (Tecartus) CoverageBaylor Scott & White Health Plan2026-10-01
    Electric Tumor Treatment Field Therapy (for Pennsylvania Only)UnitedHealthcare2026-10-01
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Factor VIII ProductsCigna2026-09-15

    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-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

    HCPCS-J9023-AVELUMAB-10MG-INJECTION

    HCPCS J9023: Avelumab Injection, 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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