Summary & Overview
HCPCS J9205: Irinotecan Liposome Injection, 1 mg
HCPCS Level II code J9205 designates the liposomal formulation of irinotecan billed per 1 mg for intravenous oncology infusion. As a chemotherapy drug code, J9205 is used in facility and professional claims to capture drug acquisition and administration costs for liposomal irinotecan across outpatient infusion settings. The code matters nationally because specialty oncology medications drive high and variable drug spend, affect site-of-care billing, and are subject to payer-specific coverage and reimbursement policies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers can expect an overview of payer coverage patterns, typical sites of service where J9205 is billed, and benchmarking context for average allowed amounts and utilization metrics where available. The summary also highlights clinical context for use as an intravenous chemotherapeutic agent and notes common billing modifiers and administrative considerations when available.
This publication provides actionable reference material for coding, billing staff, and revenue leaders seeking clarity on the clinical purpose of J9205, expected billing settings, and which major national payers commonly adjudicate claims for liposomal irinotecan. Data not available in the input will be identified where applicable.
Billing Code Overview
HCPCS Level II code J9205 represents an injection formulation of irinotecan liposome, billed per 1 mg unit. This entry describes a cytotoxic chemotherapy agent delivered intravenously in a liposomal formulation designed for oncologic indications.
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Service type: Intravenous chemotherapy administration
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Typical site of service: Hospital outpatient infusion center or oncology clinic infusion suite
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with metastatic pancreatic adenocarcinoma or other advanced solid tumor indicated for treatment with liposomal irinotecan. The patient presents to an outpatient oncology infusion center for intravenous chemotherapy. Pre-infusion steps include verification of the chemotherapy order (drug, dose in mg, infusion rate), review of recent labs (complete blood count, comprehensive metabolic panel including liver function tests), assessment of performance status, and consents. A chemotherapy-certified nurse prepares the infusion under aseptic technique using the vial formulation corresponding to J9205 (injection, irinotecan liposome, 1 mg). The drug is administered via peripheral IV or implanted port per institutional protocol; concurrent antiemetics and premedication (e.g., atropine for acute cholinergic symptoms, and antiemetics for nausea) may be given. Vital signs and infusion tolerance are monitored during and after administration. Post-infusion orders include observation for delayed diarrhea, instructions for loperamide use if needed, and scheduling of follow-up labs and oncology clinic visit to assess response and toxicity. Billing for the drug uses HCPCS code J9205 reported per milligram supplied, with appropriate modifier(s) to indicate circumstances such as bilateral services, reduced services, or discarded drug when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW |