HCPCS J9211: Idarubicin Hydrochloride Injection, 5 mg

HCPCS Level II code J9211 designates a 5 mg injection of idarubicin hydrochloride, an anthracycline chemotherapy agent used in oncology. This national-level code is central to billing for idarubicin when administered in clinical settings, affecting reimbursement workflows, drug cost reporting, and chemotherapy regimen documentation across payers. Clarity on this code supports accurate claims submission and downstream analytics for oncology care delivery.

Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of billing context, typical sites of service, and the clinical role of idarubicin as reflected by the code. The publication outlines expected benchmarks for code use, common billing modifiers in practice (listed separately), and policy considerations relevant to chemotherapy drug coding and reimbursement. It also summarizes how the code integrates into service lines for hospital outpatient and infusion-based oncology care.

This summary equips billing professionals, revenue cycle managers, and clinical administrators with the essential code definition, payer scope, and the aspects of clinical context and policy that matter when documenting and submitting claims for idarubicin 5 mg injections.

Billing Code Overview

HCPCS Level II code J9211 represents the administration of idarubicin hydrochloride, specifically an injection of 5 mg. This billing entry is used to report the drug product itself when administered to a patient.

Service type: Chemotherapy drug administration / oncology drug

Typical site of service: Hospital outpatient department, infusion center, or clinic setting

Data not available in the input.

Clinical Context

A 62-year-old patient with newly diagnosed acute myeloid leukemia (AML) presents for induction chemotherapy in an outpatient oncology infusion center or inpatient hospital unit. The oncology team prescribes idarubicin hydrochloride dosed per body surface area; pharmacy prepares J9211 billed as "Injection, idarubicin hydrochloride, 5 mg." Nursing verifies consent, performs baseline labs (CBC, CMP), confirms central venous access patency (PICC or port), and administers supportive antiemetics and hydration per protocol. Idarubicin is administered intravenously over the documented infusion time with continuous monitoring for cardiotoxicity, extravasation, and acute infusion reactions. Post-infusion monitoring includes vital signs, assessment for nausea, mucositis, and myelosuppression; follow-up clinic visits and serial labs are scheduled to manage cytopenias and adjust subsequent cycles.

Coding Specifications

Modifier	Description	When to Use
`JW`	Drug discarded/portion discarded	Use when a portion of the idarubicin vial is discarded and billing should reflect discarded amount per payer rules.
`JZ`	No drug was wasted

Taxonomy Code	Specialty	Notes
`207RG0300X`	Hematology & Oncology	Medical oncology/hematology physicians who prescribe and manage idarubicin.
`163WL0500X`	Oncology Nursing	Registered nurses specializing in oncology infusion administration and chemotherapy safety.
`333600000X`	Clinical Pharmacology	Oncology pharmacists who prepare and verify cytotoxic drug dosing and compounding.
`207L00000X`	Internal Medicine	Hospitalists or internists involved in inpatient chemotherapy management and comorbidity care.
`208500000X`	Pediatrics (Hematology/Oncology)	Pediatric oncologists when idarubicin is used in pediatric hematologic malignancies.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C92.0`	Acute myeloblastic leukemia with minimal maturation	Idarubicin is used as an induction agent for acute myeloid leukemia subtypes.
`C92.2`	Acute myelomonocytic leukemia	Represents AML variants treated with anthracycline-based regimens including idarubicin.
`C92.3`	Acute monoblastic and monocytic leukemia	Another AML subtype where idarubicin-containing induction therapy is applicable.
`C95.00`	Acute leukemia of unspecified cell type, not having achieved remission	Used during active treatment courses with agents such as idarubicin.
`C83.70`	Non-follicular lymphoma, unspecified, lymph node	Some high-grade lymphomas may be treated with anthracycline-containing regimens where idarubicin can be an alternative in select protocols.
`Z92.21`	Personal history of antineoplastic chemotherapy	Used for follow-up or later encounters documenting prior chemotherapy exposure such as idarubicin.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; non-hormonal, anti-neoplastic agent; up to 1 hour, single or initial substance/drug	Commonly billed for the intravenous administration of a single chemotherapy agent such as idarubicin when infusion time is up to 1 hour.
`96415`	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary infusion)	Billed when infusion of idarubicin extends beyond the initial hour and additional time-based units are required.
`96401`	Chemotherapy administration, intravenous infusion, push technique, single drug	Used if idarubicin is administered as an intravenous push rather than infusion, per clinical protocol.
`96417`	Chemotherapy administration, intravenous infusion technique; each additional sequential infusion of a new drug, up to 1 hour	Used when idarubicin is administered as one agent in a multi-agent sequential chemotherapy regimen during the same encounter.
`96360`	Intravenous infusion for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used for supportive intravenous therapies given in conjunction with idarubicin (e.g., hydration, antiemetic infusion) when not coded as chemotherapy administration.

OpenPayer

Summary & Overview