Summary & Overview
HCPCS J9173: Durvalumab Injection, 10 mg
HCPCS Level II code J9173 designates a 10 mg unit of durvalumab for injection, an immune checkpoint inhibitor used in oncology. As a drug-specific HCPCS Level II code, J9173 is used on outpatient and infusion service claims to represent the medication component of durvalumab therapy. Nationally, accurate use of this code matters for chemotherapy and immunotherapy billing, inventory tracking, and payer reimbursement processes for high-cost biologic agents.
Key payers in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a national overview of clinical and billing context for durvalumab injectable dosing units, payer coverage landscape, common claim modifiers, and related service-line implications. The publication outlines benchmarks for unitization and documentation expectations, summarizes recent policy and coding updates where applicable, and highlights operational considerations for infusion centers and oncology practices.
The content is intended to help revenue cycle, clinical operations, and compliance teams understand how HCPCS Level II code J9173 is applied on claims, the typical site of service for administration, and what components of billing and reporting to review when managing durvalumab therapy in outpatient infusion settings.
Billing Code Overview
HCPCS Level II code J9173 represents an injection of durvalumab, 10 mg. The service type for this code is an injectable immunotherapy medication administration, and the typical site of service is outpatient infusion or oncology clinic setting for intravenous monoclonal antibody therapy.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a solid tumor or stage III/IV non–small cell lung cancer who is prescribed durvalumab immunotherapy. The patient presents to an outpatient oncology infusion center or hospital outpatient infusion clinic for scheduled intravenous administration. A nurse verifies identity, allergies, and baseline vital signs, reviews recent laboratory results (including hepatic and renal function), and confirms the treatment plan with the oncologist. The pharmacy prepares the appropriate durvalumab dose using J9173 (10 mg unit) vial(s) per weight- or fixed-dose orders; the medication is diluted and administered via IV infusion over the recommended infusion time while monitoring for infusion reactions. Documentation includes the specific HCPCS code J9173, lot number, vial count, administered dose, start and stop times, infusion reactions, and any applicable modifier(s) to reflect supervision, bilateral procedures, or service circumstances. Typical sites of service are outpatient infusion center, hospital outpatient department, or oncology clinic.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/not administered |