HCPCS Level II J9179: Eribulin Mesylate Injection, 0.1 mg - OpenPayer

Summary & Overview

HCPCS Level II J9179: Eribulin Mesylate Injection, 0.1 mg

HCPCS Level II code J9179 represents an intravenous injection of eribulin mesylate, 0.1 mg, a systemic anticancer agent used in oncology care. Nationally, this code matters because it identifies specific drug delivery events for billing, utilization tracking, and payer coverage policies tied to cancer treatment regimens. It is used across hospital outpatient infusion centers, oncology clinics, and ambulatory infusion suites to document and bill for each unit of eribulin administered.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will learn how J9179 is applied in clinical billing workflows, the typical sites of service where eribulin is administered, and what elements influence coding and coverage decisions at a national level. The publication provides benchmarks and context for utilization, summarizes relevant policy considerations affecting reimbursement and prior authorization practices, and outlines clinical context for eribulin use without offering clinical recommendations. Where input data is missing, such as specific modifier usage patterns, ICD-10 pairings, or payer-specific fee schedules, the report notes that data is not available in the input.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ9179HCPCS Level IIeribulinchemotherapyinfusiononcologyantineoplastic agentdrug administrationoutpatient infusion

Billing Code Overview

HCPCS Level II code J9179 denotes an injection of eribulin mesylate, 0.1 mg. This code represents a systemic anticancer chemotherapy agent administered by intravenous injection. The service type is chemotherapy administration (antineoplastic agent). The typical site of service for this code is hospital outpatient infusion centers, oncology clinics, and ambulatory infusion suites where intravenous anticancer therapies are delivered.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with metastatic breast cancer or another solid tumor for which eribulin mesylate is indicated. The patient presents to an outpatient oncology infusion center for scheduled systemic chemotherapy. Prior to the visit the oncologist documents indication, prior therapies, performance status, and baseline labs (CBC, CMP). On arrival the patient is triaged, vitals are taken, and the infusion nurse verifies orders: drug J9179 (eribulin mesylate, 0.1 mg unit billing), dosage calculated from body surface area or weight, and any required premedication. Pharmacy compounds the drug in the appropriate vial/infusion bag and labels it with lot number and concentration. The nurse performs venous access (peripheral IV or implanted port) and administers eribulin per protocol, typically as an intravenous bolus/infusion over the required time with monitoring for infusion reactions, extravasation, and common toxicities (neutropenia, neuropathy, fatigue). Post‑infusion nursing documents administration, lot number, units billed based on milligram dosage (J9179 units), and provides toxicity education and follow‑up scheduling. Billing uses the HCPCS Level II code J9179 to report the medication; appropriate modifiers are appended as needed to indicate circumstances such as multiple procedures, services rendered by assistant, drug wastage, or dose not administered in full. Typical sites of service are outpatient hospital infusion centers, physician office infusion suites, or ambulatory infusion centers. Typical patient scenario: a woman with progressive metastatic breast cancer previously treated with anthracyclines and taxanes, receiving a scheduled cycle of eribulin with pre‑treatment labs showing adequate counts and no active infection, receiving the drug via an implanted port in an outpatient infusion center.

Coding Specifications

Modifier

HCPCS J9226: Histrelin Implant (Supprelin LA), 50 mg

HCPCS-J9041-BORTEZOMIB-INJECTION-0-1-MG

HCPCS J9041: Injection, bortezomib 0.1 mg

HCPCS-J9301-OBINUTUZUMAB-INJECTION-10-MG

HCPCS J9301: Obinutuzumab Injection, 10 mg

HCPCS-J9248-MELPHALAN-INJECTION-1MG

HCPCS J9248: Melphalan Injection, 1 mg

HCPCS-J9313-MOXETUMOMAB-PASUDOTOX-INJECTION-0-01MG

HCPCS Level II J9313: Injection, moxetumomab pasudotox-tdfk, 0.01 mg

HCPCS-J9209-MESNA-INJECTION-200-MG

HCPCS J9209: Mesna Injection, 200 mg

HCPCS-J9999-ANTINEOPLASTIC-DRUG-NOT-CLASSIFIED

HCPCS J9999: Not Otherwise Classified Antineoplastic Drug

HCPCS-J9331-SIROLIMUS-PROTEIN-BOUND-PARTICLES-INJECTION

HCPCS J9331: Injection, sirolimus protein-bound particles, 1 mg

HCPCS-J9055-CETUXIMAB-INJECTION-10MG

HCPCS J9055: Cetuximab Injection, 10 mg

HCPCS-J9332-EFGARTIGIMOD-ALFA-FCAB-INJECTION-2MG

HCPCS J9332: Injection, efgartigimod alfa-fcab, 2mg

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Taxonomy Code	Specialty	Notes
`207P00000X`	Medical Oncology	Primary specialty ordering and managing systemic chemotherapeutic agents such as eribulin.
`363A00000X`	Hematology/Oncology	Combined specialty often caring for patients receiving cytotoxic chemotherapy.
`164W00000X`	Hospitalist	May manage inpatient admissions related to chemotherapy complications.
`207L00000X`	Surgical Oncology	May be involved in multidisciplinary care for solid tumor patients receiving systemic therapy.
`174400000X`	Nurse Practitioner	Commonly provides chemotherapy follow‑up, assessment, and sometimes orders under supervision or collaborative practice.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50.911`	Malignant neoplasm of unspecified site of right female breast	Common primary diagnosis for which eribulin is indicated in metastatic breast cancer after prior therapy.
`C50.912`	Malignant neoplasm of unspecified site of left female breast	Same relevance for left-sided breast primary.
`C79.51`	Secondary malignant neoplasm of bone	Breast cancer frequently metastasizes to bone; eribulin is used for metastatic disease control.
`C78.7`	Secondary malignant neoplasm of liver and intrahepatic bile duct	Liver metastases are a common site of spread for breast and other solid tumors treated with eribulin.
`C79.81`	Secondary malignant neoplasm of brain	Brain metastases may coexist in patients receiving systemic therapy; impacts treatment planning and monitoring.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used when eribulin is administered as an infusion that fits the initial infusion time reporting for oncology infusion services.
`96413`	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug	Commonly reported for the administration of a chemotherapeutic agent when coding infusion services in an oncology visit.
`96415`	Each additional hour (list separately in addition to code for primary infusion)	Used when infusion time extends beyond the initial hour requiring additional time reporting.
`96417`	Chemo administration; each additional sequential infusion of a new drug, up to 1 hour	Used when multiple separate chemotherapy infusions are administered during the same visit.
`36561`	Insertion of totally implantable venous access device; subcutaneous port and catheter	Reported when a port is placed that will later be used for administration of agents such as eribulin.
`36415`	Collection of venous blood by venipuncture	Performed for baseline and monitoring labs prior to and during chemotherapy cycles.

`JW`	Drug discarded/not administered to any patient	When partial drug vial contents are discarded and the discarded amount is reported for wastage tracking (some payors may require separate reporting methods).
`JZ`	No drug administered	When no drug was administered despite being prepared (rare) and documentation supports zero administration.
`59`	Distinct procedural service	When a distinct service unrelated to other billed services is performed on the same day (for example an unrelated procedure on the same visit).
`62`	Two surgeons	When two surgeons share the performance of an operative procedure (rarely applicable but included among common modifiers).
`78`	Unplanned return to the operating/procedure room	When an unplanned return to procedure room occurs following a prior procedure (uncommonly applicable).
`80`	Assistant surgeon	When an assistant surgeon participates in a surgical procedure related to the patient’s care (not typically used for drug administration).
`82`	Assistant surgeon (when qualified resident not available)	Alternative assistant surgeon modifier when a qualified resident is not available.
`22`	Increased procedural services	When services require substantially greater effort than usual (e.g., extended observation, management of infusion complications).
`52`	Reduced services	When a service is partially reduced or not completed as originally planned (for example infusion stopped early for adverse reaction).
`53`	Discontinued procedure	When a procedure is started but discontinued due to extenuating circumstances or patient condition (e.g., infusion discontinued).
`77`	Duplicate procedure (not supplied)	Data not available in the input.
`QK`	Medical direction of two, three, or four concurrent anesthesia procedures	Not typically applicable to oncology infusion but listed among available modifiers.
`QX`	Service performed by CRNA under an arrangement with a physician	When applicable for anesthesia services (not typical for this drug administration).

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