Summary & Overview
HCPCS J9286: Injection, glofitamab-gxbm, 2.5 mg
HCPCS Level II code J9286 designates the injectable biologic glofitamab-gxbm at a 2.5 mg dose for infusion or injection. This code is used to report the drug product itself for billing purposes and is relevant for oncology practices and infusion centers administering novel monoclonal antibody therapies. Nationally, accurate coding for high-cost biologics like glofitamab-gxbm affects reimbursement, prior authorization workflows, and aggregate drug spend tracking.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks for payer coverage patterns, common claims considerations for a newly coded biologic, and clinical context about typical administration settings. The publication outlines coding interpretation, payer inclusion, and operational points relevant to billing staff, practice managers, and revenue cycle teams.
The report covers expected use cases for J9286, situates the code within outpatient infusion and clinic settings, and summarizes implications for prior authorization and reimbursement processes. Data not available in the input are noted where applicable.
Billing Code Overview
HCPCS Level II code J9286 represents an injection of glofitamab-gxbm, 2.5 mg. This code covers administration of the specified biologic agent formulated as a 2.5 mg dose.
Service Type: Drug administration (injectable biologic)
Typical Site of Service: Outpatient infusion center, physician office, or hospital outpatient department, where infusion or injectable biologic therapies are commonly administered.
Clinical & Coding Specifications
Clinical Context
A typical patient receiving J9286 (injection, glofitamab-gxbm, 2.5 mg) is an adult with relapsed or refractory B‑cell non‑Hodgkin lymphoma who has failed at least two prior systemic therapies and is eligible for bispecific antibody therapy. The clinical workflow commonly includes:
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Referral to a hematology/oncology infusion clinic following oncologist evaluation and confirmation of diagnosis and prior therapies.
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Pre‑treatment assessment: review of prior anti‑CD20 therapy, baseline laboratory studies (CBC with differential, comprehensive metabolic panel, liver function tests, coagulation profile), infectious disease screening (hepatitis B/C, HIV), and baseline imaging (PET/CT or CT) as indicated.
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Treatment planning: dosing schedule established by the treating hematologist/oncologist, with premedication orders (antipyretic, antihistamine, corticosteroid) to mitigate infusion reactions and cytokine release syndrome (CRS). Consideration for step‑up dosing or hospitalization for initial doses depending on institutional protocol.
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Administration:
J9286is administered intravenously in an oncology infusion suite, outpatient cancer center, or hospital outpatient department. The first dose or step‑up dose may be given under close monitoring (often in an observation unit or inpatient setting) with available emergency support for CRS or neurotoxicity. -
Post‑infusion monitoring: vital signs, neurologic checks, and observation for infusion reactions for a period determined by institutional policy; laboratory monitoring at planned intervals; follow‑up visits for response assessment and toxicity management.
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Billing and documentation: include the HCPCS code
J9286, applicable modifier(s) to reflect service circumstances, date and time of administration, lot and quantity information, premedications, patient tolerance, and clearly documented indication linking to the primary lymphoma diagnosis code(s).
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/not administered to any patient | When a portion of a single‑use vial of J9286 is discarded and the discarded amount is billed per payer rules |
JZ | No drug/biologic was administered | When the drug was ordered but not administered to the patient |
62 | Two surgeons | When two physicians of different specialties share responsibility for complex inpatient procedures related to lymphoma management (rare for drug admin) |
78 | Unplanned return to the operating/procedure room | If an emergency procedure is required due to an acute complication from infusion (e.g., surgical intervention for access site complication) |
80 | Assistant surgeon | When an assistant surgeon is required for a related procedure (e.g., central line placement) billed separately |
82 | Assistant surgeon (when qualified resident not available) | When a qualified assistant is needed and a resident is not available for related procedural services |
23 | Unusual anesthesia | When unusual anesthesia circumstances are required for a related procedure (not for routine infusion) |
52 | Reduced services | When the administration or related service is partially reduced or not fully performed |
53 | Discontinued procedure | If infusion is started but discontinued due to adverse reaction before completion |
22 | Unusual procedural services | When work involved in preparation or administration is substantially greater than typical (document justification) |
| Taxonomy Code | Specialty | Notes |
|---|---|---|
207RH0000X | Hematology & Oncology | Primary specialists who prescribe and oversee J9286 therapy |
333600000X | Infusion Therapy | Providers and facilities specializing in parenteral oncology medication administration |
363L00000X | Hematology | Hematology specialists involved in diagnosis and management of B‑cell lymphomas |
207L00000X | Medical Oncology | Medical oncologists partnering in systemic therapy decisions |
Related Diagnoses
| ICD-10 Code | Description | Clinical Relevance |
|---|---|---|
C83.30 | Diffuse large B-cell lymphoma, unspecified, unspecified site | Common aggressive B‑cell lymphoma subtype for which bispecific antibody therapy like glofitamab may be used in relapsed/refractory disease |
C85.80 | Other specified non‑Hodgkin lymphoma, unspecified site | Applies to less specifically typed non‑Hodgkin lymphomas considered for advanced immunotherapy |
C83.70 | Mantle cell lymphoma, unspecified, unspecified site | Mantle cell lymphoma that is relapsed/refractory may be treated with novel agents including bispecific antibodies in clinical practice or trials |
C83.90 | Non‑follicular lymphoma, unspecified, unspecified site | Broad category capturing non‑follicular lymphomas eligible for targeted immunotherapy |
C82.90 | Follicular lymphoma, unspecified, unspecified site | Indolent B‑cell lymphoma that can become relapsed/refractory and require advanced therapies |
Related CPT Codes
| CPT Code | Description | Relationship to This Procedure |
|---|---|---|
96413 | Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug | Used for the intravenous infusion of J9286 when the infusion time is up to 1 hour for the initial drug |
96415 | Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary infusion) | Billed when infusion of J9286 exceeds the initial hour and additional infusion time is required |
96417 | Chemotherapy administration, intravenous infusion technique; each additional sequential infusion of a new drug (different substance) | When multiple intravenous oncology drugs are administered sequentially during the same visit in addition to J9286 |
36415 | Collection of venous blood by venipuncture | Routine blood draws for baseline and monitoring labs before/after J9286 administration |
36556 | Insertion of non-tunneled centrally inserted central venous catheter, age 5 years or older | When a central venous access device is placed to facilitate infusion of J9286 or other concurrent therapies |