Summary & Overview
HCPCS J9272: Injection, dostarlimab-gxly, 10 mg
HCPCS Level II code J9272 denotes the injection of dostarlimab-gxly, 10 mg, a specialty oncology monoclonal antibody administered by infusion. This code matters nationally as immunotherapy agents like dostarlimab are high-cost, clinician-administered therapies with significant implications for outpatient infusion practice, payer coverage policies, and hospital outpatient reimbursement. Payers commonly involved in coverage and payment for this service include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare.
Readers will find a concise overview of the clinical context for J9272, typical sites of service, and which payers are relevant to coverage considerations. The publication summarizes benchmarking information where available, highlights policy and coding considerations that affect billing for specialty oncology infusions, and outlines how this HCPCS Level II code is used on service lines for parenteral administration. Data not available in the input will be explicitly noted in supporting sections. The summary provides clinicians, billing professionals, and policy analysts a clear reference for identifying this code, understanding its clinical use, and locating detailed benchmarks and policy updates within the full publication.
Billing Code Overview
HCPCS Level II code J9272 represents an injectable biologic medication: dostarlimab-gxly, 10 mg. The service type is injection delivered as a parenteral oncology or specialty infusion therapy. The typical site of service is an ambulatory infusion center, hospital outpatient infusion clinic, or physician office infusion suite where specialty oncology biologics are administered.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with recurrent or advanced mismatch repair–deficient (dMMR) or microsatellite instability–high (MSI-H) solid tumor, such as endometrial or colorectal carcinoma, who is receiving systemic immunotherapy with dostarlimab-gxly (PD-1 inhibitor). The medication billed as J9272 (injection, dostarlimab-gxly, 10 mg) is administered by an oncology infusion nurse in an outpatient infusion center, ambulatory clinic, or hospital outpatient department. The workflow includes physician order verification, pre-infusion assessment (vital signs, review of prior infusion tolerance, laboratory checks for hepatic and renal function), preparation of the drug by pharmacy (dose calculation based on weight or fixed dosing per prescribing information), IV access placement, infusion per protocol with monitoring for infusion-related reactions and immune-related adverse events, documentation of lot number and units administered, and billing using J9272 units corresponding to milligram dose dispensed. Typical settings: outpatient oncology infusion center, hospital outpatient infusion suite, or ambulatory infusion clinic. Common clinical team members: medical oncologist, oncology pharmacist, infusion nurse, and billing/coding specialist.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
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