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HCPCS J9023: Avelumab 10 mg Injection

HCPCS Level II code J9023 denotes a 10 mg injection of avelumab, an immunotherapy agent used in oncology. As a drug-specific HCPCS Level II code, J9023 is used on medical claims to identify the administered biologic separately from the infusion or visit. Nationally, accurate use of this code matters for clinical documentation, billing clarity, and payer adjudication for high-cost oncology therapies.

Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for avelumab injections, billing considerations tied to HCPCS Level II coding, and typical sites of service where the drug is administered. The publication summarizes common modifiers associated with drug administration in general and notes when data elements are not available in the input.

This report provides practical benchmarks and policy-oriented context relevant to health plans and providers: how the code is used on claims, typical service settings, and the national importance of precise coding for oncology biologic therapies. Data not available in the input are called out where applicable.

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Billing Code Overview

HCPCS Level II code J9023 represents an injection of avelumab, dosed per the descriptor as 10 mg. This code covers the drug product when administered as an injectable oncology biologic.

Service type: Drug administration (intravenous infusion or injection)

Typical site of service: Outpatient infusion center or hospital outpatient department

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

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HCPCS J9023: Avelumab 10 mg Injection

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Sign up for hcpcs J9023 policy alerts

Get alerted when payer policies referencing J9023 are released or updated.

Monitor payer policy activity

Receive email alerts as soon as relevant payer policies are published or updated.

Billing Code Overview

HCPCS Level II code J9023 represents an injection of avelumab, dosed per the descriptor as 10 mg. This code covers the drug product when administered as an injectable oncology biologic.

Service type: Drug administration (intravenous infusion or injection)

Typical site of service: Outpatient infusion center or hospital outpatient department

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with metastatic urothelial carcinoma or other FDA‑approved indication for avelumab who presents to an outpatient oncology infusion suite for scheduled immunotherapy. The patient has a recent oncology consultation documenting indication, treatment plan, and baseline labs (CBC, CMP) and is assessed by oncology nursing prior to infusion for vitals, performance status, and checklist screening for contraindications such as active infection or uncontrolled autoimmune disease. The clinician orders J9023 to cover avelumab dosed per weight or fixed schedule; pharmacy verifies dose, prepares the vial dose under sterile compounding conditions, and documents lot number and expiration. On the day of service the patient receives intravenous infusion in the oncology chair or ambulatory infusion center, monitored for infusion reactions; premedication (e.g., antihistamine, acetaminophen) may be administered per protocol. Post‑infusion monitoring occurs for the required observation period; nursing documents administration details, any adverse events, and disposition. Billing for the drug uses HCPCS code J9023 per 10 mg increment with appropriate modifier(s) for payer reporting and reimbursement, and relevant diagnosis codes for the oncologic indication are submitted with the claim.

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (standard)	Use when no special circumstances apply to the service.
`11`	Active/ongoing treatment	Use to indicate the patient is receiving active avelumab therapy as part of ongoing treatment.
`22`	Increased procedural service	Use when unusually high complexity of drug preparation or administration is documented.
`52`	Reduced services	Use when only part of the charged service was performed (e.g., partial vial not administered) and documented.
`53`	Discontinued procedure	Use when infusion is started but discontinued due to adverse reaction and documented.
`62`	Two physicians/Co-surgeon	Rare for drug administration; use only if two physicians are documented as performing distinct portions of the service.
`78`	Return to operating/procedure room for related procedure	Use only if patient returns to procedure area for a complication related to the infusion and billed to the same payor.
`80`	Assistant surgeon	Generally not applicable; include only if an assistant surgeon meets payer criteria for an associated procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for physician‑administered drugs	Use when a qualified non‑physician practitioner administers or supervises administration per payer policy.
`JW`	Drug discarded/not administered	Use when part of the vial is discarded and documentation supports discarded amount for wastage reporting.
`JZ`	No wastage/entire drug administered	Use when all of the prepared avelumab dose was administered and no wastage occurred.
`Q6`	Services furnished in a non‑participating hospital outpatient department	Use for billing distinctions when services occur in a hospital outpatient setting per payer rules.
`QX`	CRNA service with medical direction by doctor of medicine or osteopathy	Use if a CRNA is involved in anesthesia care for an associated procedure during the same encounter.
`TG`	Item furnished in whole blood or blood components testing program	Use only if transfusion services or special testing related to the infusion are billed under program rules.

Taxonomy Code	Specialty	Notes
208000000X	Medical Oncology	Primary specialty ordering and overseeing avelumab therapy.
207Q00000X	Hematology‑Oncology	Specialists managing systemic cancer therapy including immunotherapy.
364S00000X	Infusion Therapy	Nursing specialty performing administration and monitoring.
261QM0800X	Pharmacy	Oncology pharmacists preparing and verifying compounded biologic agents.
363L00000X	Nurse Practitioner	Advanced practice providers who may order and administer therapy under protocol.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C67.9`	Malignant neoplasm of bladder, unspecified	Avelumab is FDA‑approved for certain cases of urothelial carcinoma; bladder cancer is a common indication.
`C79.11`	Secondary malignant neoplasm of lung	Metastatic disease sites for which systemic immunotherapy including avelumab may be indicated.
`C80.1`	Malignant (primary) neoplasm, unspecified	Used when primary site is unspecified but systemic immunotherapy is indicated.
`C76.2`	Malignant neoplasm of pleura, unspecified	Thoracic metastatic involvement potentially managed with systemic immunotherapy.
`Z92.24`	Personal history of antineoplastic chemotherapy	Documented history relevant to current immunotherapy planning and prior treatments.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Often billed for the infusion time when avelumab is administered as the initial IV infusion during the encounter.
`96415`	Chemotherapy administration, IV infusion, each additional hour	Billed when infusion duration exceeds the initial hour and additional time is medically documented.
`96417`	Chemotherapy administration, IV infusion, each additional sequential infusion of a new drug, up to 1 hour	Used if avelumab is followed by an additional distinct IV drug in the same encounter.
`96401`	Chemotherapy administration, IV infusion, for antineoplastic agents; not otherwise specified	Alternate administration code for complex or non‑standard infusion services when applicable.
`99199`	Unlisted special service, procedure or report	Used rarely for reporting unusual services related to immunotherapy administration not covered by standard codes.

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 J9010: Injection, Alemtuzumab 10 mg

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

HCPCS Level II J9011: Injection, datopotamab deruxtecan-dlnk, 1 mg

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

HCPCS J9015: Aldesleukin Injection, Single-Use Vial

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

HCPCS J9017: Injection, Arsenic Trioxide, 1 mg

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

HCPCS J9019: Asparaginase (erwinaze) Injection, 1,000 IU

HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

HCPCS J9020: Injection, Asparaginase, 10,000 Units

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

HCPCS J9021: Injection, Asparaginase (Rylaze), 0.1 mg

HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

HCPCS J9022: Atezolizumab Injection, 10 mg

Showing 1–10 of 227

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Modifier	Description	When to Use
`00`	No modifier (standard)	Use when no special circumstances apply to the service.
`11`	Active/ongoing treatment	Use to indicate the patient is receiving active avelumab therapy as part of ongoing treatment.
`22`	Increased procedural service	Use when unusually high complexity of drug preparation or administration is documented.
`52`	Reduced services	Use when only part of the charged service was performed (e.g., partial vial not administered) and documented.
`53`	Discontinued procedure	Use when infusion is started but discontinued due to adverse reaction and documented.
`62`	Two physicians/Co-surgeon	Rare for drug administration; use only if two physicians are documented as performing distinct portions of the service.
`78`	Return to operating/procedure room for related procedure	Use only if patient returns to procedure area for a complication related to the infusion and billed to the same payor.
`80`	Assistant surgeon	Generally not applicable; include only if an assistant surgeon meets payer criteria for an associated procedure.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for physician‑administered drugs	Use when a qualified non‑physician practitioner administers or supervises administration per payer policy.
`JW`	Drug discarded/not administered	Use when part of the vial is discarded and documentation supports discarded amount for wastage reporting.
`JZ`	No wastage/entire drug administered	Use when all of the prepared avelumab dose was administered and no wastage occurred.
`Q6`	Services furnished in a non‑participating hospital outpatient department	Use for billing distinctions when services occur in a hospital outpatient setting per payer rules.
`QX`	CRNA service with medical direction by doctor of medicine or osteopathy	Use if a CRNA is involved in anesthesia care for an associated procedure during the same encounter.
`TG`	Item furnished in whole blood or blood components testing program	Use only if transfusion services or special testing related to the infusion are billed under program rules.

Taxonomy Code	Specialty	Notes
208000000X	Medical Oncology	Primary specialty ordering and overseeing avelumab therapy.
207Q00000X	Hematology‑Oncology	Specialists managing systemic cancer therapy including immunotherapy.
364S00000X	Infusion Therapy	Nursing specialty performing administration and monitoring.
261QM0800X	Pharmacy	Oncology pharmacists preparing and verifying compounded biologic agents.
363L00000X	Nurse Practitioner	Advanced practice providers who may order and administer therapy under protocol.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C67.9`	Malignant neoplasm of bladder, unspecified	Avelumab is FDA‑approved for certain cases of urothelial carcinoma; bladder cancer is a common indication.
`C79.11`	Secondary malignant neoplasm of lung	Metastatic disease sites for which systemic immunotherapy including avelumab may be indicated.
`C80.1`	Malignant (primary) neoplasm, unspecified	Used when primary site is unspecified but systemic immunotherapy is indicated.
`C76.2`	Malignant neoplasm of pleura, unspecified	Thoracic metastatic involvement potentially managed with systemic immunotherapy.
`Z92.24`	Personal history of antineoplastic chemotherapy	Documented history relevant to current immunotherapy planning and prior treatments.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Often billed for the infusion time when avelumab is administered as the initial IV infusion during the encounter.
`96415`	Chemotherapy administration, IV infusion, each additional hour	Billed when infusion duration exceeds the initial hour and additional time is medically documented.
`96417`	Chemotherapy administration, IV infusion, each additional sequential infusion of a new drug, up to 1 hour	Used if avelumab is followed by an additional distinct IV drug in the same encounter.
`96401`	Chemotherapy administration, IV infusion, for antineoplastic agents; not otherwise specified	Alternate administration code for complex or non‑standard infusion services when applicable.
`99199`	Unlisted special service, procedure or report	Used rarely for reporting unusual services related to immunotherapy administration not covered by standard codes.

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 J9010: Injection, Alemtuzumab 10 mg

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

HCPCS Level II J9011: Injection, datopotamab deruxtecan-dlnk, 1 mg

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

HCPCS J9015: Aldesleukin Injection, Single-Use Vial

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

HCPCS J9017: Injection, Arsenic Trioxide, 1 mg

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

HCPCS J9019: Asparaginase (erwinaze) Injection, 1,000 IU

HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

HCPCS J9020: Injection, Asparaginase, 10,000 Units

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

HCPCS J9021: Injection, Asparaginase (Rylaze), 0.1 mg

HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

HCPCS J9022: Atezolizumab Injection, 10 mg

Showing 1–10 of 227

References

1.CPT® Codes and Descriptions. AAPC. Retrieved Jul 29, 2026.
2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.
3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Jul 29, 2026.

Published by

Trek Health powers OpenPayer with a leading commercial payer intelligence platform, seamlessly converting fragmented payer data into actionable insights for provider organizations.

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HCPCS J9023: Avelumab 10 mg Injection

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Billing Code Overview

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HCPCS J9023: Avelumab 10 mg Injection

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Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References

Clinical & Coding Specifications

Clinical Context

Coding Specifications

Related Diagnoses

Related CPT Codes

Related Codes

References