Summary & Overview
HCPCS J9196: Gemcitabine Hydrochloride Injection, 200 mg
HCPCS Level II code J9196 designates a 200 mg injection of gemcitabine hydrochloride (accord), explicitly noting it is not therapeutically equivalent to J9201. As a chemotherapy drug administration code, it is used on claims to identify provision of this specific antineoplastic agent in outpatient and clinic infusion settings. Nationally, accurate coding for injectable chemotherapy agents matters for clinical tracking, payer adjudication, and pharmacovigilance.
Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical and billing context for J9196, including the drug formulation and typical sites of service. The publication outlines common payer coverage considerations and reporting practices, highlights benchmark and utilization context where available, and summarizes coding distinctions relative to similarly named products (noting the non-equivalence to J9201).
This resource is intended for billing managers, revenue cycle staff, and clinical administrators who need a clear, national-level summary of what HCPCS Level II code J9196 represents, and what to expect in claim submission and documentation requirements. Data on associated taxonomies, ICD-10 pairings, and related codes: Data not available in the input.
Billing Code Overview
HCPCS Level II code J9196 describes an injection of gemcitabine hydrochloride (accord), 200 mg unit, and specifies that it is not therapeutically equivalent to J9201. This code represents a specific biologic/chemotherapy drug product formulation provided as an injectable medication.
Service type: Drug administration / injectable chemotherapy
Typical site of service: Outpatient infusion center, hospital outpatient department, or clinic where parenteral chemotherapy is administered
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
Clinical & Coding Specifications
Clinical Context
A 64-year-old female with metastatic pancreatic adenocarcinoma presents to the outpatient oncology infusion center for scheduled chemotherapy. The treating oncologist has ordered single-agent gemcitabine hydrochloride supplied as the branded product J9196 billed per 200 mg unit because the specific manufacturer (Accord) was dispensed and is not therapeutically equivalent to J9201.
The clinical workflow: the patient is registered, consented for chemotherapy, and triaged by the nurse for vital signs and laboratory review (CBC, basic metabolic panel). Pharmacy verifies the order, compounds the intravenous infusion of gemcitabine per body surface area, and labels vials/syringes with lot and expiration. The medication administration record documents lot number and administration time; the clinician documents indication, regimen cycle number, pre-medications if given, and any infusion-related reactions. Billing captures the drug using J9196 units (per 200 mg) and appends appropriate modifiers for circumstances such as billing entity (AS), drug wastage (JW), or medically necessary unusual services (22) where applicable.
Coding Specifications
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