Summary & Overview
HCPCS J9145: Daratumumab Injection, 10 mg
HCPCS Level II code J9145 denotes a 10 mg unit of daratumumab, a monoclonal antibody used in oncology and hematology settings. As a drug-specific HCPCS code, J9145 is essential for billing and reimbursement of daratumumab infusions across outpatient infusion centers, hospital outpatient departments, and physician offices. Nationally, accurate use of this code affects payer coverage determinations, prior authorization workflows, and facility revenue capture for high-cost biologic therapies.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication outlines payer coverage patterns, billing benchmarks, and clinical context for use of daratumumab, including how unit-based billing translates to infusion encounters and dose calculation. Readers will find concise benchmarks for per-unit billing, common billing considerations for infusion settings, and an overview of policy updates that influence utilization and prior authorization. Where input data is not provided, the report notes missing elements. This summary serves clinicians, billing professionals, and policy analysts seeking a national perspective on billing practices and administrative considerations for daratumumab using HCPCS Level II code J9145.
Billing Code Overview
HCPCS Level II code J9145 represents an injection of daratumumab, billed per 10 mg unit. The service is a pharmacologic/infusion drug administration related to intravenous monoclonal antibody therapy.
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Service type: Injection, specialty oncology/hematology biologic therapy
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Typical site of service: Infusion center, hospital outpatient department, or physician office providing injectable oncology therapies
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is a 65-year-old with relapsed or refractory multiple myeloma who presents to an outpatient oncology infusion center for intravenous monoclonal antibody therapy. The drug administered is daratumumab dosed and billed per 10 mg units (J9145). The workflow includes pre-visit eligibility and benefit verification with payors (Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), pre-medication orders (acetaminophen, antihistamine, corticosteroid), baseline vital signs and infusion center nursing assessment, placement of an intravenous peripheral line or use of a central venous catheter, and initiation of infusion under oncology nursing supervision. Vital signs and infusion tolerance are documented at regular intervals; infusion rate adjustments and management of infusion-related reactions are performed as indicated. Post-infusion, a brief observation period occurs and documentation of drug lot number, NDC, dose in mg, total units billed (J9145 per 10 mg), and applicable modifiers is completed before discharge and claims submission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug wastage discarded | When partial vials are discarded and wastage is reported separately if payer allows |