Summary & Overview
HCPCS Level II J9278: Carboplatin (avyxa) Injection, 1 mg
HCPCS Level II code J9278 designates an injection of carboplatin (avyxa), billed per 1 mg. As a chemotherapy drug administration code, J9278 is used across outpatient infusion settings and inpatient billing workflows to capture the unitized cost of this cytotoxic agent. Nationally, accurate coding for single-agent chemotherapies like carboplatin affects drug reimbursement, inventory management, and oncology cost reporting.
Key payers addressed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for carboplatin injections, the typical sites of service where this HCPCS code is used, and the implications for billing and claims processing. The publication outlines benchmark considerations for unit-based drug billing, highlights common coding touchpoints relevant to oncology practices and infusion centers, and summarizes policy and coverage themes that commonly affect chemotherapy drug claims. This resource is intended for billing managers, revenue cycle teams, oncology clinicians who interact with claims, and policy analysts seeking a clear reference for J9278 in national payer contexts.
Billing Code Overview
HCPCS Level II code J9278 represents an injection of carboplatin (avyxa) measured per 1 mg. This code describes the drug formulation and unit of service for carboplatin administered by injection.
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Service type: Injectable chemotherapy agent
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Typical site of service: Hospital outpatient department, clinic infusion center, or physician office infusion setting
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Clinical & Coding Specifications
Clinical Context
A typical patient is an adult oncology patient receiving systemic chemotherapy for a solid tumor such as ovarian, lung, or head and neck cancer where carboplatin is part of the regimen. The patient presents to the outpatient oncology infusion clinic or hospital infusion center for scheduled chemotherapy. The clinical workflow includes confirmation of the chemotherapy order specifying J9278 (carboplatin, 1 mg units), verification of recent lab results (complete blood count, renal function), allergy and consent checks, preparation of the appropriate carboplatin dose by pharmacy based on body surface area or AUC calculations, administration via intravenous infusion using an ambulatory infusion pump or IV infusion set, monitoring for infusion-related reactions and hematologic toxicity, and documentation of lot number, dose administered, and site of service. Typical site of service is an outpatient hospital infusion center or physician office oncology infusion suite.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
59 | Distinct procedural service | When a separate, distinct procedure or service not normally reported together is performed on the same day unrelated to the infusion code |
76 |