Summary & Overview
HCPCS Level II J9026: Injection, tarlatamab-dlle, 1 mg
HCPCS Level II code J9026 identifies the injectable oncology biologic tarlatamab-dlle, billed per 1 mg. This code matters nationally as it standardizes reporting and reimbursement for a novel cancer-directed immunotherapy administered via infusion, impacting hospital outpatient departments and oncology clinics. Accurate use of J9026 affects claims processing, clinical inventory tracking, and payer coverage determinations for high-cost specialty medications.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication summarizes benchmark pricing, payer coverage patterns, and coding considerations relevant to these major national payers.
Readers will learn the clinical context for tarlatamab-dlle administration, typical sites of service, common billing modifiers and documentation touchpoints, and the implications of accurate HCPCS Level II coding for claims and reimbursement workflows. The report also highlights areas where policy updates or payer-specific coverage rules commonly affect billing outcomes. Data not available in the input will be noted where applicable.
Billing Code Overview
HCPCS Level II code J9026 represents the medication tarlatamab-dlle, billed per 1 mg for injectable administration. The service type is injectable oncology/biologic therapy, typically delivered in hospital outpatient infusion centers or specialized oncology clinics depending on clinical setting and payer coverage.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A patient with relapsed or refractory small cell lung cancer (SCLC) presents to an outpatient oncology infusion center for administration of J9026 (injection, tarlatamab-dlle, 1 mg). Typical patient is an adult with progressive disease after prior chemotherapy, referred by a medical oncologist. Pre-visit evaluation includes review of recent imaging, laboratory studies (CBC with differential, comprehensive metabolic panel), assessment of performance status, and documentation of informed consent specific to tarlatamab-dlle therapy and potential immune-related adverse events. On the day of service, nursing performs pre-infusion vitals, medication reconciliation, and establishes IV access. The biologic is prepared by pharmacy based on the ordered milligram dose and labeled per facility policy. During administration, patients are monitored for infusion reactions, cytokine release syndrome, and other immune-mediated effects; vital signs are recorded at protocol-defined intervals. Post-infusion observation is performed per institutional and manufacturer guidance before discharge with outpatient follow-up scheduled with the treating oncologist for toxicity assessment and next dosing cycle planning.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug/unit not administered to patient (discarded) | When a portion of a single-dose vial is discarded and cannot be billed to patient; bill for amount administered and for discarded amount as required by payor. |