Summary & Overview
HCPCS Level II J9027: Clofarabine Injection, 1 mg
HCPCS Level II code J9027 denotes a 1 mg unit of clofarabine, an antineoplastic agent used in oncology. This code identifies the drug product itself rather than the administration procedure, and it matters nationally because accurate coding of high-cost chemotherapy agents drives drug reimbursement, claims adjudication, and utilization monitoring across payers. Proper use of J9027 affects coverage determinations, patient cost-sharing, and provider billing for infusion services.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context for clofarabine as an injectable chemotherapy agent, common sites of service for its administration, and the role of HCPCS Level II coding in billing for oncology drugs. The publication outlines typical payer considerations and what to expect in claims processing for a billed unit of clofarabine.
The content provides national-level benchmarks and policy-oriented context where available, summarizes billing implications for outpatient infusion centers and oncology clinics, and identifies gaps where input data are not provided. Data not available in the input will be noted explicitly in relevant sections.
Billing Code Overview
HCPCS Level II code J9027 represents an injection of clofarabine, 1 mg. The service type is injectable chemotherapy agent administration, typically furnished as a parenteral oncology drug. The typical site of service for this medication is hospital outpatient infusion centers, oncology clinics, or other outpatient infusion settings where intravenous or subcutaneous chemotherapeutic agents are administered.
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult or pediatric oncology patient diagnosed with relapsed or refractory acute lymphoblastic leukemia (ALL) or other hematologic malignancy for which clofarabine is indicated. The patient presents to an outpatient infusion center, hospital outpatient department, or inpatient oncology unit for administration of J9027 (injection, clofarabine, 1 mg). Clinic workflow includes pre-infusion assessment (vitals, review of labs including CBC, renal and hepatic function), verification of chemotherapy orders by an oncologist, pharmacy preparation and verification of the individualized clofarabine dose, bedside verification using two identifiers, and administration via intravenous infusion or bolus per protocol. Monitoring during and after infusion includes assessment for infusion reactions, fluid status, infection signs, and laboratory trend review to manage myelosuppression and organ toxicity. Documentation captures drug name, total mg administered, lot number, infusion start and stop times, consenting clinician, and any adverse events. Billing uses J9027 multiplied by the total milligrams administered, with applicable modifiers as indicated for service circumstances.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Unmodified service | Standard reporting when no modifier applies |