Summary & Overview
HCPCS J9076: Injection, Cyclophosphamide (Baxter) 5 mg
HCPCS Level II code J9076 denotes a 5 mg unit of cyclophosphamide (Baxter) for injection, a chemotherapy agent used across multiple oncology indications. Nationally, accurate coding for chemotherapy drugs matters for drug utilization tracking, billing consistency, and oncology care delivery financing. This code identifies the specific manufacturer product and unit dose, supporting dose-based billing and inventory control.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna, UnitedHealthcare, and Medicare. Readers will find context on clinical use and sites of service, plus what to expect in payer coverage patterns for chemotherapy drug J-codes. The publication outlines benchmarks commonly reviewed by payers (unit dosing and per-dose billing), clinical context for cyclophosphamide use, and where policy updates typically impact reimbursement and prior authorization practices.
The report provides practical reference material for billing staff and revenue-cycle teams: a concise description of the drug code, typical sites where the service is delivered, and the scope of payer coverage examined. Data limitations are noted where source details were not provided. This summary is written for a national audience and does not address state-specific policies.
Billing Code Overview
HCPCS Level II code J9076 represents an injection of cyclophosphamide (Baxter), 5 mg. This code describes the drug product and unit of service for administration of cyclophosphamide, an alkylating agent used in chemotherapy regimens.
Service Type: Chemotherapy drug administration / Pharmaceutical drug unit
Typical Site of Service: Hospital outpatient department, infusion center, or oncology clinic
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A 62-year-old female with relapsed non-Hodgkin lymphoma is scheduled for outpatient intravenous chemotherapy with single-agent cyclophosphamide (Baxter) for cytoreduction prior to combination therapy. The patient arrives to the oncology infusion clinic, is triaged by a registered nurse, vital signs documented, and pre-medication orders reviewed. The oncologist confirms indication, dosage calculated by body surface area, and pharmacy prepares the J9076 drug vial(s) in a sterile compounding area. The infusion nurse verifies identity, allergy history, and chemotherapy consent, administers an antiemetic per protocol, and gives the cyclophosphamide via IV push or short infusion as ordered. Post-administration monitoring includes observation for infusion reactions, assessment of nausea, and documentation of the administered amount in milligrams and vial count. Billing is submitted using J9076 reported per 5 mg unit with applicable modifiers to reflect service details (e.g., billing for drug wastage, split/shared services, professional component) and facility taxonomy codes for the treating provider type. Typical site of service is an oncology infusion center or outpatient hospital infusion department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/amount not administered |