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    v1.0.28
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9198-gemcitabine-100mg-infusion
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    HCPCS Level II J9198: Gemcitabine Hydrochloride Injection, 100 mg

    HCPCS Level II code J9198 denotes an injectable chemotherapy agent, gemcitabine hydrochloride (Infugem), 100 mg, administered as an intravenous antineoplastic infusion; the service is chemotherapy drug administration typically provided in hospital outpatient infusion centers or oncology clinics for systemic cancer treatment.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with a solid tumor diagnosis (for example, metastatic pancreatic, non-small cell lung, or bladder cancer) receiving outpatient intravenous chemotherapy with gemcitabine (J9198, per 100 mg). The patient arrives to the oncology infusion center or hospital outpatient infusion suite for a scheduled cycle. Clinical workflow: triage and vital signs, review of laboratory results (complete blood count, renal and hepatic panels) to confirm adequate counts and organ function, verification of the chemotherapy order and dose calculation (weight- or body-surface-area–based), preparation of gemcitabine by pharmacy under sterile compounding procedures, administration via intravenous infusion (often over 30 minutes to 2 hours depending on regimen), monitoring during and after infusion for infusion reactions and hematologic toxicities, documentation of lot numbers and units administered, and billing using J9198 with appropriate modifier(s) to reflect circumstances of the service.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugCommon CPT code for administration of an IV infusion of gemcitabine when infusion time is up to 1 hour.
    96415Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary infusion)Used when gemcitabine infusion extends beyond the initial hour and additional hourly time must be reported.
    96417Chemotherapy administration, intravenous infusion technique; each additional sequential infusion, up to 1 hour (when multiple drugs administered)Applicable when gemcitabine is administered as part of a multi-drug infusion sequence requiring separate time reporting.
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hourSometimes used for infusion administration of supportive IV therapies given with chemotherapy (e.g., hydration prior to gemcitabine).
    96401Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic, single drugUse if gemcitabine were administered by a non-IV route (rare); generally not applicable to standard IV dosing.
    36415Collection of venous blood by venipuncturePerformed prior to each cycle for required laboratory monitoring (CBC, chemistries) to assess fitness for gemcitabine dosing.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RC0000XCardiovascular Disease PhysicianAn internist who specializes in diseases of the heart and blood vessels and manages complex cardiac conditions such as heart attacks and life-threaten…
    207RH0000XHematology (Internal Medicine) PhysicianAn internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
    363A00000XPhysician AssistantA physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and…
    367A00000XAdvanced Practice MidwifeAdvanced practice midwifery encompasses the independent provision of care during pregnancy, childbirth, and the postpartum period; sexual and reproduc…
    207RI0200XInfectious Disease PhysicianAn internist who deals with infectious diseases of all types and in all organ systems. Conditions requiring selective use of antibiotics call for this…
    163WS0121XPlastic Surgery Registered NurseNursing Service Providers · Registered Nurse
    2080P0205XPediatric Endocrinology PhysicianA pediatrician who provides expert care to infants, children and adolescents who have diseases that result from an abnormality in the endocrine glands…
    207QP0002XPhysician Nutrition Specialist (Family Medicine)A physician who specializes in the diagnosis and treatment of primary nutritional diseases (e.g., undernutrition, overnutrition, and genetic or acquir…

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J9000-DOXORUBICIN-10MG-INJECTION

    HCPCS J9000: Doxorubicin Hydrochloride Injection, 10 mg

    HCPCS-J9003-LEUPROLIDE-INJECTABLE-CAMCEVI-1MG

    HCPCS Level II J9003: Leuprolide injectable (camcevi etm), 1 mg

    HCPCS-J9010-ALEMTUZUMAB-INJECTION-10MG

    HCPCS Level II J9010: Injection, alemtuzumab, 10 mg

    HCPCS-J9011-DATOPOTAMAB-DERUXTECAN-INJECTION-1MG

    HCPCS J9011: Datopotamab Deruxtecan Injection, 1 mg

    HCPCS-J9015-ALDESLEUKIN-INJECTION-SINGLE-USE-VIAL

    HCPCS Level II J9015: Aldesleukin Injection, Single-Use Vial

    HCPCS-J9017-ARSENIC-TRIOXIDE-INJECTION-1MG

    HCPCS J9017: Arsenic Trioxide Injection, 1 mg

    HCPCS-J9019-ASPARAGINASE-ERWINAZE-INJECTION-1000-IU

    HCPCS Level II J9019: Asparaginase (Erwinaze) Injection, 1,000 IU

    HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

    HCPCS J9020: Asparaginase Injection, 10,000 Units

    HCPCS-J9021-ASPARAGINASE-RYLAZE-INJECTION-0-1-MG

    HCPCS Level II J9021: Injection, asparaginase (Rylaze), 0.1 mg

    HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

    HCPCS J9022: Injection, atezolizumab 10 mg

    Showing 1–10 of 227

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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