Summary & Overview
HCPCS J9155: Degarelix Injection, 1 mg
HCPCS Level II code J9155 denotes a 1 mg injection of degarelix, an injectable gonadotropin-releasing hormone antagonist used in androgen deprivation therapy for prostate cancer. As a drug-specific HCPCS Level II code, J9155 is used on medical claims to identify administered degarelix units and to support clinical and financial tracking of oncology drug use across outpatient settings. Nationally, accurate coding for injectable oncology agents affects provider reimbursement, eligibility for pharmacy vs. medical benefit coverage, and program integrity oversight.
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 clinical context for degarelix, typical sites of service where the injection is administered, and the role of J9155 in claims processing. The publication also summarizes benchmarking elements and policy considerations commonly associated with HCPCS drug codes, such as unit reporting, billing practice implications, and payer coverage dynamics. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J9155 represents an injection of degarelix, 1 mg. This code describes the drug administration of degarelix, a gonadotropin-releasing hormone (GnRH) antagonist used in oncology for androgen deprivation therapy.
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Service type: Drug administration (injectable oncology medication)
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Typical site of service: Administration commonly occurs in outpatient oncology clinics, physician offices, and hospital outpatient departments where injectable cancer therapies are provided.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult male diagnosed with advanced prostate cancer requiring androgen deprivation therapy. The patient presents to an outpatient oncology or urology clinic for administration of J9155 (degarelix) as a monthly subcutaneous injection. The clinical workflow includes verification of the indication and recent testosterone and PSA levels, informed consent, assessment for prior hypersensitivity to gonadotropin-releasing hormone (GnRH) antagonists, medication reconciliation, and documentation of baseline vital signs. The nurse prepares the pre-filled syringe of degarelix, applies aseptic technique, and administers the subcutaneous injection to the abdominal or thigh area. Observation for immediate injection-site reaction or systemic adverse effects (e.g., hot flashes, injection-site erythema, allergic reaction) follows for a short period before discharge. Scheduled follow-up visits include monitoring of PSA and testosterone suppression, management of side effects, and coordination of subsequent monthly injections or switch to alternative androgen deprivation therapy if clinically indicated.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
11 | Modifier for increased procedural services (professional) | Use when a physician provides increased work effort beyond typical for the administration visit (e.g., significant additional counseling or management). |