Summary & Overview
HCPCS J9184: Gemcitabine Hydrochloride (avyxa), 200 mg Injection
HCPCS Level II code J9184 denotes a 200 mg unit of gemcitabine hydrochloride (avyxa) administered as an injectable chemotherapy agent. Nationally, accurate use of this code matters for oncology drug billing, drug utilization monitoring, and payer coverage determinations because gemcitabine is a commonly used cytotoxic agent across multiple cancer indications. Proper coding separates the drug product charge from infusion and administration services, affecting claims adjudication and policy application.
This publication reviews coverage and benchmarking for major payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of billing conventions for J9184, payer-specific reimbursement considerations, common service settings, and clinical context for gemcitabine use. The report highlights typical places of service (hospital outpatient departments and physician office infusion suites) and clarifies that the code reports the drug unit rather than administration.
What readers will learn: payer coverage patterns, coding and billing implications for chemotherapy drug units, comparable HCPCS billing considerations, and where to find further policy references. Data not available in the input will be explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code J9184 represents an injection of gemcitabine hydrochloride (avyxa), 200 mg. This code describes a single drug administration unit of gemcitabine formulated for intravenous infusion and is used to report the administered medication itself rather than separate infusion services or professional administration time.
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Service type: Injectable chemotherapy agent (intravenous infusion)
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Typical site of service: Hospital outpatient infusion center, physician office infusion suite, or outpatient oncology clinic
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Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with locally advanced pancreatic adenocarcinoma presents to the outpatient oncology infusion center for systemic chemotherapy. The oncology team prescribes gemcitabine hydrochloride dosed per body surface area for palliative systemic therapy or as part of a multi-agent regimen. The clinical workflow begins with nursing intake (vital signs, weight, height, review of recent labs including CBC and liver function tests), allergy and concurrent medication check, and verification of the chemotherapy order. Pharmacy compounds the J9184 vial(s) of gemcitabine hydrochloride into an appropriate IV bag under sterile conditions and performs dose verification. The patient is escorted to the infusion chair; an intravenous peripheral line or implanted port is accessed and flushed. The infusion nurse administers supportive pre-medications if ordered, initiates the gemcitabine infusion per protocol (rate and duration), monitors for infusion reactions and cytopenias, documents administration using J9184 units (200 mg per HCPCS unit), and provides post-infusion instructions. Follow-up includes lab monitoring prior to subsequent cycles and oncology clinic visit for response assessment and toxicity management.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service |