Summary & Overview
HCPCS Level II J9274: Injection, tebentafusp-tebn, 1 microgram
HCPCS Level II code J9274 denotes the injectable oncology biologic tebentafusp-tebn, billed per 1 microgram unit. This code matters nationally as tebentafusp is an emergent targeted therapy used in oncology care pathways and its per-microgram billing unit influences dosing, ordering, and cost reporting across settings that deliver infusion therapies. The analysis addresses how major national payers approach coverage and claims adjudication for this high-cost injectable therapy.
Key payers covered in the analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise policy and payment overview, payer benchmarking, and clinical context relevant to infusion delivery — including expected sites of service. The publication outlines common billing considerations tied to per-unit HCPCS reporting, typical service lines involved with administration, and payer coverage patterns.
Readers will learn practical benchmarks for unit-based billing of tebentafusp-tebn, recent policy updates affecting specialty drug coding and reimbursement, and clinical setting implications for oncology infusion services. Data not available in the input where specific payer policies, associated taxonomies, ICD-10 diagnoses, and related codes would normally appear.
Billing Code Overview
HCPCS Level II code J9274 describes Injection, tebentafusp-tebn, 1 microgram. This billing code represents the drug product tebentafusp-tebn supplied as an injectable medication; the service type is drug administration/injectable therapy. The typical site of service for this treatment is hospital outpatient infusion centers or oncology clinics where parenteral oncology therapies are administered.
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult diagnosed with HLA-A02:01–positive, unresectable or metastatic uveal melanoma who is scheduled to receive tebentafusp-tebn. The medication, billed as J9274 per microgram, is administered by intravenous infusion in an outpatient oncology infusion center or hospital outpatient department. A usual clinical workflow: pre-infusion clinic visit for consent, baseline labs (CBC, CMP, liver function tests), and HLA-A02:01 confirmation; verify vial/dose and prepare infusion by pharmacy; premedication as indicated (antipyretic/antihistamine) and nursing assessment at arrival; infusion with close monitoring for cytokine release syndrome (CRS) and infusion-related reactions during and for several hours after infusion; post-infusion observation, documentation of administered micrograms and remaining wastage (if any), and billing with appropriate modifier(s) to indicate discarded drug (JW) or no waste (JZ) and site/clinical circumstances. Typical patient scenario includes prior lines of therapy for metastatic disease, baseline performance status assessment, and enrollment in a specialty drug management program as tebentafusp-tebn is a targeted biologic requiring specific handling and monitoring.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW |