Summary & Overview
HCPCS Level II J9052: Carmustine Injection, 100 mg
HCPCS Level II code J9052 denotes a 100 mg injectable dose of carmustine (accord), a chemotherapeutic agent used in oncology care. This code is distinguished from J9050 by its non‑therapeutic equivalence designation, which affects billing specificity and inventory tracking. Nationally, accurate use of J9052 matters for chemotherapy coding precision, reimbursement integrity, and monitoring utilization of provider‑administered oncology drugs.
Key payers addressed in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks on payer coverage patterns, common claim edits and billing considerations, and clinical context for when carmustine is used. The publication outlines coding best practices for service lines that administer systemic chemotherapy, typical sites of service where J9052 is billed, and the implications of non‑therapeutic equivalence for drug substitution and billing.
The report provides actionable reference material for coding teams, revenue cycle staff, and policy analysts seeking clarity on drug‑specific HCPCS coding, payer interactions, and operational impacts of administering carmustine using J9052. Data not available in the input.
Billing Code Overview
HCPCS Level II code J9052 represents an injection of carmustine (accord), 100 mg, explicitly noted as not therapeutically equivalent to J9050. This code denotes a single-dose drug administration typically used in chemotherapy regimens involving carmustine.
Service Type: Injectable chemotherapy drug administration
Typical Site of Service: Hospital outpatient infusion center or specialized oncology clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a primary central nervous system or systemic malignancy for which nitrosourea chemotherapy is indicated, such as recurrent glioblastoma multiforme or metastatic carcinoma with central nervous system involvement. The patient presents to an outpatient oncology infusion clinic or hospital outpatient oncology unit for scheduled intravenous chemotherapy. The oncology nurse verifies identity, performs baseline vital signs and laboratory review (including CBC and renal/hepatic panels), and prepares the dose of carmustine drawn from a pharmacy-prepared vial labeled as J9052 (carmustine (accord), 100 mg). The infusion is administered via peripheral IV or implanted central venous access device (e.g., port-a-cath) under standard chemotherapy safety precautions. The clinical workflow includes premedication if required, infusion over the recommended time, monitoring for acute infusion reactions, documentation of lot number and discarded waste (modifier JW when applicable), and post-infusion monitoring and discharge instructions. Typical site of service is an outpatient infusion center, hospital outpatient department, or ambulatory chemotherapy suite. Common clinical indications include primary brain tumors and other cancers where carmustine is part of the chemotherapy regimen.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW |