Summary & Overview
HCPCS J9219: Leuprolide Acetate Implant, 65 mg
HCPCS Level II code J9219 denotes a 65 mg leuprolide acetate implant, a long-acting hormonal therapy delivery form used in specialty and outpatient settings. This code is relevant nationally for oncology, urology, and endocrinology practices that administer sustained-release gonadotropin-releasing hormone (GnRH) agonist therapy. Accurate coding for implantable drug delivery affects clinical documentation, claims processing, and payment consistency across payers.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context of long-acting leuprolide implants, typical sites of service, and which payers commonly reimburse for this HCPCS Level II drug code. The publication outlines common billing modifiers used with drug administration claims and highlights where data is available or not available in the input.
This summary equips revenue cycle managers, billing professionals, and policy analysts with a clear statement of what J9219 represents, the clinical settings in which it is used, and the types of payer coverage considerations to review when processing claims.
Billing Code Overview
HCPCS Level II code J9219 represents leuprolide acetate implant, 65 mg. This billing code denotes a pharmaceutical implant formulation of leuprolide acetate used for systemic hormonal therapy.
-
Service type: Drug administration via implant
-
Typical site of service: Ambulatory infusion clinics, outpatient specialty clinics, and other settings where long-acting hormonal implants are placed and managed
Clinical & Coding Specifications
Clinical Context
A 34-year-old woman with endometriosis presents to a gynecology clinic for management of severe pelvic pain and large endometriotic implants refractory to first-line hormonal therapy. The gynecologist determines treatment with a 65 mg leuprolide acetate implant for depot gonadotropin-releasing hormone (GnRH) agonist therapy is appropriate to induce medical ovarian suppression for 3–6 months. The clinical workflow includes: history and exam; counseling on expected menopausal symptoms and bone density considerations; obtaining baseline pregnancy test and, if indicated, baseline bone mineral density; informed consent; scheduling insertion of the leuprolide acetate implant in an outpatient procedure suite; administration of local anesthesia; subcutaneous implant insertion by a qualified provider; documentation of lot number and implant site; post-procedure observation and discharge instructions for expected side effects and follow-up for implant removal/replacement per manufacturer guidance.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier (standard) | Use when no special circumstances apply to the billed J-code service. |
22 | Increased procedural services |