Summary & Overview
HCPCS J9217: Leuprolide Acetate Depot Suspension, 7.5 mg
HCPCS Level II code J9217 identifies leuprolide acetate (for depot suspension), 7.5 mg, a long-acting GnRH agonist formulation used in oncology, urology, and select gynecologic and pediatric indications. As a drug code, it matters nationally because it drives billing for depot injectable therapy in outpatient settings and informs payer coverage, prior authorization workflows, and cost-sharing for patients receiving hormonal suppression therapy. Key payers in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will learn what the code represents clinically and operationally, which payers’ policies and benchmarks are typically assessed, and what elements affect billing and reimbursement for depot leuprolide products. The publication covers pricing and utilization benchmarks, common payer policy features such as coverage criteria and prior authorization practices, and the clinical contexts where J9217 is applied. It also outlines typical sites of service and the service type tied to the code. Data not present in the input—such as specific payer coverage rules, ICD-10 pairings, and associated taxonomies—is noted as unavailable.
Billing Code Overview
HCPCS Level II code J9217 represents leuprolide acetate (for depot suspension), 7.5 mg. This billing code denotes the drug formulation and unit quantity for leuprolide acetate supplied as a depot suspension used in various clinical indications where long-acting gonadotropin-releasing hormone (GnRH) agonist therapy is indicated.
Service Type: Depot injectable medication administration
Typical Site of Service: Outpatient clinic, physician office, or ambulatory infusion center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving leuprolide acetate (for depot suspension), 7.5 mg (J9217) as part of ongoing androgen deprivation therapy for prostate cancer or as treatment for endometriosis or uterine fibroids in gynecologic care. The clinical workflow begins with an outpatient or infusion clinic visit where a licensed prescriber documents the indication, reviews recent labs (e.g., PSA for prostate cancer or pregnancy test for women of childbearing potential), confirms informed consent, and documents medical necessity. A nurse or clinician prepares and administers the intramuscular depot injection, observes the patient for immediate adverse reactions for 15–30 minutes, and records lot and expiration numbers in the chart. Subsequent dosing is scheduled per the treatment regimen (often monthly for the 7.5 mg depot). Billing uses the HCPCS Level II code J9217 for the drug supplied; an appropriate administration CPT code and modifier(s) may be appended as required by payer policy. Typical sites of service include outpatient infusion centers, physician office/clinic, and ambulatory surgical centers when combined with other procedures.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/partial dose |