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    v1.0.31
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9256-nipocalimab-injection-3mg
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    HCPCS Level II J9256: Injection, nipocalimab-aahu, 3 mg

    HCPCS Level II code J9256 describes an injectable monoclonal antibody product, nipocalimab-aahu, billed per 3 mg unit; the service is an injection typically administered in an outpatient infusion center or clinic setting and is coded for billing when the specified 3 mg unit of the drug is dispensed and provided to the patient.

    For related coverage guidance, see recent payer policy updates: Bendamustine Products Coverage Criteria, T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and Romidepsin, Brentuximab Vedotin (Adcetris®) Coverage Criteria.

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    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult with an autoimmune or alloantibody-mediated hematologic or immunologic condition receiving intravenous monoclonal antibody therapy. The medication J9256 represents nipocalimab-aahu, billed per 3 mg increment. The patient presents to an infusion center, hospital outpatient infusion clinic, or specialty infusion suite for administration. Pre-infusion nursing assessment includes vital signs, review of allergies and prior infusion reactions, current medications, and verification of weight and renal/hepatic status as indicated. An order from an immunologist, hematologist, rheumatologist, or transfusion medicine specialist is required, specifying dose (converted to mg and translated to billing units of J9256), infusion rate, and premedication if needed.

    On the day of service, an infusion nurse performs IV access, verifies informed consent and identity, and documents baseline assessments. The infusion is administered per protocol with continuous monitoring for infusion reactions; vital signs are recorded at defined intervals. Post-infusion observation occurs for the clinically appropriate period. Documentation includes start/stop times, lot number and manufacturer of the product, total mg administered, number of J9256 units billed (3 mg per unit), and any adverse events. Billing is submitted to the patient’s payer with appropriate facility and professional components and any applicable modifiers for services such as emergency administration, bilateral procedures (not applicable here), or reduced services if partial dosing occurs. Typical sites of service: hospital outpatient infusion center, physician office-based infusion suite, or freestanding infusion center.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96365Intravenous infusion, initial, up to 1 hourUsed when the initial infusion of nipocalimab-aahu is administered and monitored for up to 1 hour.
    96366Intravenous infusion, each additional hourUsed when the infusion extends beyond the first hour and additional hourly monitoring is billed.
    96367Intravenous infusion, each additional sequential infusion of a new drugUsed when another distinct intravenous drug infusion is administered sequentially during the same visit.
    36415Collection of venous blood by venipunctureUsed for required pre-infusion laboratory testing or therapeutic monitoring prior to administration.
    99070Supplies and materials provided by the physician over and above those usually included with the serviceUsed to bill for additional infusion supplies not included in the primary infusion code when payer allows.
    96374Therapeutic, prophylactic, or diagnostic injection (specify substance or drug); subcutaneous or intramuscular

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    77Modifier 77 indicates that a previously performed procedure or service was legitimately repeated by a different physician or other qualified health care professional. The AMA’s CPT definition…- Use modifier 77 when a basic procedure or service already performed is repeated by a different physician or other qualified health care professional (for example, a second provider independently…
    24Modifier 24 denotes an unrelated evaluation and management (E/M) service performed by the same physician or qualified healthcare professional during a postoperative global period. Per CPT guidance,…- Use modifier 24 when you report an evaluation and management (E/M) service performed by the same physician or same-specialty group during a procedure’s postoperative global period that is unrelated…
    1PModifier 1P is a Category II performance measure exclusion modifier used to indicate that a patient’s medical condition prevented performance of the action specified by a Category II quality measure…- Use modifier 1P only with Category II (quality reporting) codes when the specific measure’s reporting instructions explicitly allow a medical-reason exclusion; it marks the patient as medically…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    207RH0000X
    2080P0207X
    207K00000X
    363L00000X
    310400000X
    103TM1700X
    208D00000X
    2279P1005X

    Related ICD-10-CM Codes

    24 rows

    ICD-10-CM CodeDescription
    B20Human immunodeficiency virus [HIV] disease
    D70.9Neutropenia, unspecified
    D73.4Cyst of spleen
    D80.1Nonfamilial hypogammaglobulinemia
    D80.9Immunodeficiency with predominantly antibody defects, unspecified
    D83.9Common variable immunodeficiency, unspecified
    D84.9Immunodeficiency, unspecified
    D89.9Disorder involving the immune mechanism, unspecified
    G61.0Guillain-Barre syndrome
    J84.10Pulmonary fibrosis, unspecified

    Showing 1–10 of 24

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    10 rows

    PolicyPayerEffective Date
    Bendamustine Products Coverage Criteriablue cross blue shield - tennessee2027-01-30
    T-Cell Lymphoma Agents: Beleodaq, Istodax, Lymphir, Poteligeo, and RomidepsinMass General Brigham Health Plan2027-01-04
    Brentuximab Vedotin (Adcetris®) Coverage Criteriablue cross blue shield - tennessee2026-12-31
    Pemetrexed Coverageblue cross blue shield - tennessee2026-12-31
    Tumor Treatment Fields - Medical PolicyHealth-New-England2026-12-01
    Extracorporeal PhotopheresisCigna2026-11-15
    VonvendiCigna2026-11-15
    Hematology - AphexdaCigna2026-11-15
    Extracorporeal PhotopheresisCigna2026-11-15
    Yartemlea (narsoplimab-wuug) Coverage for TA-TMANeighborhood Health Plan of Rhode Island2026-11-01

    Related Codes

    HCPCS-J9000-DOXORUBICIN-10MG-INJECTION

    HCPCS J9000: Doxorubicin Hydrochloride Injection, 10 mg

    HCPCS-J9003-LEUPROLIDE-INJECTABLE-CAMCEVI-1MG

    HCPCS Level II J9003: Leuprolide injectable (camcevi etm), 1 mg

    HCPCS-J9010-ALEMTUZUMAB-INJECTION-10MG

    HCPCS Level II J9010: Injection, alemtuzumab, 10 mg

    HCPCS-J9011-DATOPOTAMAB-DERUXTECAN-INJECTION-1MG

    HCPCS J9011: Datopotamab Deruxtecan Injection, 1 mg

    HCPCS-J9015-ALDESLEUKIN-INJECTION-SINGLE-USE-VIAL

    HCPCS Level II J9015: Aldesleukin Injection, Single-Use Vial

    HCPCS-J9017-ARSENIC-TRIOXIDE-INJECTION-1MG

    HCPCS J9017: Arsenic Trioxide Injection, 1 mg

    HCPCS-J9019-ASPARAGINASE-ERWINAZE-INJECTION-1000-IU

    HCPCS Level II J9019: Asparaginase (Erwinaze) Injection, 1,000 IU

    HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

    HCPCS J9020: Asparaginase Injection, 10,000 Units

    HCPCS-J9021-ASPARAGINASE-RYLAZE-INJECTION-0-1-MG

    HCPCS Level II J9021: Injection, asparaginase (Rylaze), 0.1 mg

    HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

    HCPCS J9022: Injection, atezolizumab 10 mg

    Showing 1–10 of 227

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Used when a related subcutaneous or IM medication (e.g., premedication) is administered in the same clinical workflow.