Summary & Overview
HCPCS J9225: Histrelin Implant (Vantas), 50 mg
HCPCS Level II code J9225 denotes the 50 mg histrelin implant (Vantas), an implantable formulation of a gonadotropin-releasing hormone agonist used for sustained hormone suppression. Nationally, this code is relevant for specialty pharmacies, ambulatory surgical centers, hospital outpatient departments, and prescribers managing conditions that require long-acting GnRH suppression.
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 the implant formulation, typical sites of service where implantation occurs, and the payer landscape that commonly adjudicates claims for implantable injectable therapies.
The publication provides benchmarks and operational guidance on billing and service-line classification, summarizes common modifiers and administrative considerations (when available), and outlines areas where policy updates or payer-specific requirements commonly affect coverage and claim processing. It is intended to inform revenue cycle teams, clinicians involved in implant placement, and coding professionals about the coding designation and the practical implications of reporting J9225 for implantable histrelin therapy.
Data not available in the input for specific associated taxonomies, ICD-10 diagnoses, and related codes.
Billing Code Overview
HCPCS Level II code J9225 represents histrelin implant (Vantas), 50 mg. This code is used to report the medication implant formulation of histrelin, a gonadotropin-releasing hormone (GnRH) agonist.
Service Type: Drug administration via implant
Typical Site of Service: Outpatient surgical or ambulatory procedural setting, including ambulatory surgery centers and hospital outpatient departments where implant placement is performed.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult male or female diagnosed with advanced prostate cancer or central precocious puberty being treated with a long‑acting gonadotropin‑releasing hormone (GnRH) agonist. The provider schedules insertion of a single subcutaneous histrelin implant (J9225, 50 mg) as part of androgen deprivation therapy for prostate cancer or puberty suppression for pediatric patients. The clinical workflow includes pre‑procedure evaluation (history, medication review, informed consent), baseline labs (testosterone, PSA for prostate cancer; baseline growth and bone age in pediatrics as indicated), and a minor outpatient office procedure under local anesthesia. The implant is placed in the subdermal tissue of the inner upper arm or abdominal wall per device instructions. Post‑procedure care includes wound care instructions, a short observation period, documentation of implant lot and expiration, coding the drug supply as J9225, and scheduling follow‑up visits for efficacy monitoring and eventual implant removal/replacement (typically annually). Common sites of service are outpatient physician office, ambulatory surgery center, or outpatient hospital clinic depending on patient age and comorbidities.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No specific modifier (default) |