Summary & Overview
HCPCS J9153: Liposomal Daunorubicin and Cytarabine Injection
HCPCS Level II code J9153 designates an injectable liposomal chemotherapy product combining daunorubicin and cytarabine (1 mg daunorubicin and 2.27 mg cytarabine per unit). This code is significant nationally because it identifies billing for a specialized cytotoxic agent used in oncology infusion settings and supports capture of drug utilization, administration patterns, and payer coverage determinations across outpatient sites.
Key payers referenced in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what the code represents, the typical clinical setting for administration, payer coverage considerations, and the types of benchmarks and policy items commonly assessed for high-cost oncology drugs. The publication outlines expected service lines and sites of service, common billing modifiers observed in practice (input provided), and where to look for associated clinical and coding guidance.
This summary equips revenue cycle, clinical, and policy stakeholders with the essential context for J9153, enabling clearer alignment between clinical documentation, site-of-service reporting, and payer engagement. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J9153 represents an injectable, liposomal combination formulation containing 1 mg daunorubicin and 2.27 mg cytarabine. This code is used to bill for the specific liposomal chemotherapy product as described, administered as an infusion.
Service Type: Chemotherapy infusion (liposomal combination agent)
Typical Site of Service: Hospital outpatient infusion center, oncology clinic, or outpatient infusion center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory acute myeloid leukemia (AML) scheduled to receive a liposomal formulation combining daunorubicin and cytarabine (J9153) as part of induction or salvage chemotherapy. The patient is evaluated in an oncology clinic or hospital hematology service, including baseline labs (CBC, CMP), cardiac assessment (echocardiogram or MUGA) for anthracycline exposure, and review of prior therapies. On the day of service, chemotherapy consent is confirmed, central venous access (PICC, port, or tunneled catheter) is accessed and assessed, pre-medications (antiemetic, hydration as indicated) are administered, and J9153 is prepared by pharmacy under sterile conditions and delivered to the infusion suite or inpatient floor. Nursing performs chemotherapy administration per institutional protocol with continuous monitoring for infusion reactions, extravasation risk, and cytopenia-related complications. Post-infusion orders include monitoring labs, infection prophylaxis as indicated, and scheduling follow-up visits for response assessment and subsequent cycles.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier - default | Use when no special circumstances apply and no other modifier is appropriate. |
| | Office or outpatient visit for evaluation and management | Use when reporting an E/M service that qualifies as the primary service on the same date in an outpatient oncology encounter.