Summary & Overview
HCPCS J9226: Histrelin Implant (Supprelin LA), 50 mg
HCPCS Level II code J9226 denotes the histrelin implant (Supprelin LA), 50 mg, a long-acting GnRH agonist delivered via subcutaneous implant for sustained hormone suppression. This code captures an implantable pharmaceutical device used primarily in specialty outpatient settings for conditions requiring potent, prolonged suppression of gonadotropin signaling. Nationally, implants like this influence pharmacy and device spend, specialty care workflows, and payer coverage policies because of high unit costs and procedural components associated with insertion and removal.
Key payers in the national analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of coverage considerations across major payers, typical sites of service and clinical context for use, and the billing elements tied to this HCPCS Level II code. The publication outlines benchmarks and common billing scenarios, highlights policy updates affecting implantable GnRH therapies, and provides clarity on coding scope where the code covers the 50 mg histrelin implant itself. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J9226 represents histrelin implant (supprelin la), 50 mg, a long-acting gonadotropin-releasing hormone (GnRH) agonist delivered as a subcutaneous implant. The service type is pharmacologic implant therapy for sustained hormone suppression. The typical site of service for this implant is outpatient specialty clinics or ambulatory surgical centers, including endocrine and pediatric endocrinology clinics where implants are placed and removed.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adolescent or adult with central precocious puberty, gender dysphoria undergoing puberty suppression, or hormone-sensitive conditions requiring long-acting gonadotropin-releasing hormone (GnRH) agonist therapy. The service involves placement of a subdermal Histrelin implant (J9226, 50 mg) in an outpatient ambulatory surgical center or office-based procedure room. Clinical workflow: pre-procedure evaluation and consent by a pediatric endocrinologist or reproductive endocrinologist; verification of diagnosis and prior authorization as needed; procedural sedation or local anesthesia administered by an MD, DO, or qualified CRNA/RN under supervision; aseptic prep and subdermal insertion of the implant in the upper arm or trunk; observation for immediate complications; documentation of implant lot number and placement site; scheduling for planned removal or replacement typically at 12 months. Typical site of service: outpatient ambulatory surgery center or physician office procedure room. Typical patient scenario: a 9-year-old female with rapidly progressive secondary sexual characteristics and confirmed central precocious puberty receives a J9226 Histrelin implant placed under local anesthesia after payer authorization, with post-procedure observation and follow-up endocrine monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 |