Summary & Overview
HCPCS J9038: Injection, axatilimab-csfr, 0.1 mg
HCPCS Level II code J9038 denotes the injectable biologic axatilimab-csfr, billed per 0.1 mg unit. As a drug-specific HCPCS code, it identifies the product and dosing increment for infusion or injection services and is used on medical claims when axatilimab-csfr is administered in outpatient infusion centers, hospital outpatient departments, or similar settings. Nationally, unique HCPCS drug codes such as J9038 matter because they drive drug identification on medical claims, support coverage and payment determinations, and enable tracking of utilization and spending for high-cost biologics.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code’s clinical role, typical settings of administration, and the payer landscape relevant to reimbursement and coverage processes. The publication provides benchmark-oriented content on coding and billing practice for injectable biologics, summarizes common modifier use (listed separately), and highlights where readers can expect policy updates or payer-specific coverage rules to influence claim adjudication. Clinical context around axatilimab-csfr’s administration and billing implications is included to assist coding, billing, and policy teams in understanding how HCPCS Level II code J9038 is applied in practice.
Billing Code Overview
HCPCS Level II code J9038 represents an injection of axatilimab-csfr, with each unit equal to 0.1 mg. This code describes the drug product and dosing unit for administration of axatilimab-csfr.
Service Type: Drug administration / injectable biologic
Typical Site of Service: Outpatient infusion center or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a rare or refractory autoimmune or hematologic condition being treated with axatilimab-csfr delivered as an intravenous injection. The patient presents to an outpatient infusion center or hospital outpatient department for scheduled biologic therapy after clinician review of recent laboratory results and infection screening. Nursing performs pre‑infusion vitals, verifies identity and consent, confirms medication lot number and dose calculated in 0.1 mg units, and establishes IV access. The infusion is administered under direct supervision of an oncology/immunology clinician with post‑infusion observation for infusion reaction. Documentation includes start and stop times, total drug amount billed using J9038 (per 0.1 mg unit), any administration modifiers, and any premedication or rescue medications given for hypersensitivity. Typical sites of service are outpatient infusion centers, hospital outpatient departments, and, less commonly, physician office infusion suites.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
22 | Increased procedural services | Use when work or complexity of administration is substantially greater than usual (document justification). |
23 |