Summary & Overview
HCPCS J9202: Goserelin Acetate Implant, 3.6 mg
HCPCS Level II code J9202 denotes goserelin acetate implant, per 3.6 mg, a GnRH agonist delivered as a subcutaneous implant for endocrine suppression in oncology and other hormone‑sensitive conditions. This national code is used to bill the implantable drug component of care where the product is provided to the patient, and it matters for consistent drug reporting, payer coverage decisions, and provider reimbursement across outpatient settings.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for use of goserelin implants, typical sites of service, common billing modifiers, and the role of HCPCS Level II coding in documenting drug implants. The publication also highlights benchmarks and policy considerations relevant to coverage and claims processing, and points to where additional clinical and billing details are typically found.
This summary is written for a national audience and focuses on code definition, operational implications for outpatient administration, and payer coverage context. Data not available in the input is noted where applicable in detailed sections.
Billing Code Overview
HCPCS Level II code J9202 describes goserelin acetate implant, per 3.6 mg. This code represents a medication implant formulation of the gonadotropin‑releasing hormone (GnRH) agonist goserelin used for endocrine therapy in relevant clinical indications.
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Service type: Drug administration via implant
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Typical site of service: Ambulatory procedures or outpatient settings where implants are placed (for example, clinic infusion rooms or ambulatory surgical centers)
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with hormone-sensitive prostate cancer under active management or a premenopausal woman with estrogen receptor‑positive breast cancer requiring medical ovarian suppression. The clinician (medical oncologist, urologist, or gynecologic oncologist) prescribes a goserelin acetate implant J9202 for depot subcutaneous implantation every 28 days (3.6 mg) per product labeling. The clinical workflow includes: a pre‑procedure visit to confirm indication, review of contraindications and consent, baseline labs (testosterone or estradiol and relevant tumor markers), and scheduling of an outpatient minor procedure. On the day of service the patient is positioned supine; local antisepsis and local anesthetic are administered to the medial or lateral abdominal wall; a small trocar or inserter is used to place the implant subcutaneously; hemostasis is confirmed and a sterile dressing applied. Post‑procedure observations focus on injection‑site reaction, acute pain control, and counseling about expected endocrine effects and follow‑up dosing. Documentation includes the drug name and HCPCS code J9202, dose per implant (3.6 mg), number of units administered, route (subcutaneous), site, lot number, and status of device/implant. Typical sites of service are outpatient clinic, physician office, ambulatory surgery center, or hospital outpatient department where minor procedures are performed under local anesthesia. Common patient scenarios include initiation of androgen deprivation therapy for advanced prostate cancer, adjuvant ovarian suppression for premenopausal breast cancer during systemic therapy, or symptom control for hormone‑sensitive metastatic disease.
Coding Specifications
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