J9293 Mitoxantrone — HCPCS Reimbursement Benchmarks | OpenPayer

Summary & Overview

HCPCS J9293: Mitoxantrone Hydrochloride Injection, per 5 mg

HCPCS Level II code J9293 denotes the per-5 mg billing unit for mitoxantrone hydrochloride, an antineoplastic injection used in oncology care. Nationally, accurate reporting of this HCPCS code matters for chemotherapy administration tracking, cost accounting, and payer reimbursement for infused cancer therapies. Mitoxantrone is used in select cancer and hematologic treatment protocols, making precise unit-based billing important for dose-based payment and utilization monitoring.

Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise briefing on clinical context and service settings, unit and site-of-service implications for billing, and typical payer coverage considerations. The publication outlines common benchmarks for unit reporting and notes payer-specific coverage patterns where available.

This summary also highlights practical implications for claims submission when using J9293, such as unit-based dosing documentation and infusion site reporting. Data not available in the input are identified clearly when applicable. The content is intended for national audiences including billing professionals, oncology clinic administrators, and policy analysts seeking a clear reference for J9293.

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareMedicareJ9293HCPCS Level IImitoxantronechemotherapyinfusiononcologydrug billingoutpatient infusionantineoplastic

Billing Code Overview

HCPCS Level II code J9293 represents an injection of mitoxantrone hydrochloride, billed per 5 mg. This medication is a cytotoxic antineoplastic agent used in certain oncology and hematology treatment regimens.

Service Type: Chemotherapy / Antineoplastic Injection

Typical Site of Service: Hospital outpatient infusion center, oncology clinic, or specialty infusion center

Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.

Clinical & Coding Specifications

Clinical Context

A typical patient is an adult with metastatic breast cancer or relapsed acute myeloid leukemia receiving intravenous mitoxantrone hydrochloride for cytotoxic therapy. The drug billed under J9293 is dosed per 5 mg; actual administered dose is calculated from body surface area (BSA) and oncologist prescription. Clinical workflow: patient presents to an oncology infusion center or hospital outpatient oncology unit for scheduled chemotherapy. Pre-infusion nursing assessment includes vital signs, laboratory review (complete blood count, liver and renal function), chemotherapy consent verification, and review of prior cardiac function (eg, echocardiogram or MUGA) due to mitoxantrone’s cardiotoxicity. Pharmacy compounds and dispenses the weight- and BSA-based dose; the dose is documented in mg and then converted to billing units of J9293 per 5 mg. Nursing performs IV access verification, administers pre-medications if indicated, infuses mitoxantrone over the prescribed infusion time with appropriate safety checks, monitors for infusion reactions, and documents lot numbers and waste. Post-infusion monitoring includes observation for immediate adverse effects, scheduling follow-up labs and oncology visits, and updating the chemotherapy administration record. Typical site of service: outpatient hospital infusion center, physician office infusion suite, or ambulatory infusion center. Common patient scenario: a 58-year-old woman with metastatic breast cancer receiving cycle-based chemotherapy with mitoxantrone as part of combination therapy, BSA-calculated dose converted to J9293 billing units, administered via peripheral IV or implanted port with pre- and post-infusion monitoring and documentation.

Coding Specifications

Modifier	Description

HCPCS J9214: Interferon alfa-2b injection, 1 million units

HCPCS-J9262-OMACETAXINE-MEPESUCCINATE-INJECTION

HCPCS J9262: Injection, omacetaxine mepesuccinate, 0.01 mg

HCPCS-J9359-LONCASTUXIMAB-TESIRINE-INJECTION

HCPCS Level II J9359: Loncastuximab Tesirine Injection, 0.075 mg

HCPCS-J9316-PERTUZUMAB-TRASTUZUMAB-HYALURONIDASE-INJECTION

HCPCS J9316: Injection of Pertuzumab and Trastuzumab with Hyaluronidase

HCPCS-J9285-OLARATUMAB-INJECTION-10MG

HCPCS Level II J9285: Injection, olaratumab, 10 mg

HCPCS-J9318-ROMIDEPSIN-INJECTION-0-1-MG

HCPCS Level II J9318: Romidepsin Injection, Non-Lyophilized, 0.1 mg

HCPCS-J9601-LINVOSELTAMAB-INJECTION-1MG

HCPCS J9601: Injection, linvoseltamab-gcpt, 1 mg

HCPCS-J9178-EPIRUBICIN-INJECTION-2MG

HCPCS J9178: Epirubicin HCl Injection, 2 mg

HCPCS-J9219-LEUPROLIDE-ACETATE-IMPLANT-65MG

HCPCS J9219: Leuprolide Acetate Implant, 65 mg

HCPCS-J9058-BENDAMUSTINE-HCL-INJECTION-1MG

HCPCS Level II J9058: Bendamustine Hydrochloride Injection, 1 mg

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`00`	No modifier — standard claim	Use when no special circumstances apply and professional or technical modifiers are not required.
`11`	Professional component	Use when billing only the professional component of a related service (rare for drug-only HCPCS).
`22`	Increased procedural services	Use when work or resources exceed typical requirements (document supporting rationale).
`52`	Reduced services	Use when the drug administration or associated service was partially reduced or not completed.
`53`	Discontinued procedure	Use when infusion was started but discontinued for reasons such as adverse reaction or medical necessity.
`62`	Two surgeons	Use when two qualified providers are involved in technical aspects of care for the infusion (rare).
`78`	Return to OR for related procedure following initial service	Generally not applicable to routine infusions; use only if patient returns to procedure suite for complications.
`80`	Assistant surgeon	Rarely applicable; use if an assistant surgeon is documented for a related invasive procedure.
`JW`	Drug discarded/not administered	Use when a portion of a single-use vial is discarded and must be reported as unused drug discarded (specific payer rules apply).
`QX`	Qualified non-physician practitioner service furnished; modifier may be used to identify services by CRNAs, PAs, or NPs	Use when a qualified non-physician practitioner performs the infusion under appropriate supervision.
`QY`	Service furnished under a physician's supervision by a PA/NP/clinical nurse specialist where required	Use when the supervision requirements are met and billed accordingly.
`AS`	Physician assistant, nurse practitioner, or clinical nurse specialist services for anesthesia	Use only if related anesthesia services are billed by an advanced practitioner.
`JW`	Drug discarded/not administered	Use to report discarded portion of a single-use vial when required by payer (duplicate entry consolidated above; include once on claim as applicable).
`UD`	Unclassified drug modifier (used to indicate U.S. Flag for clinical trial or specific coding per payer)	Use when coding for investigational drug reporting or specific payer-required identification.

Taxonomy Code	Specialty	Notes
`208000000X`	Medical Oncology	Primary specialty ordering and overseeing chemotherapy infusions including mitoxantrone.
`207RC0000X`	Hematology	Manages hematologic malignancies (eg, acute myeloid leukemia) treated with mitoxantrone.
`363A00000X`	Nursing — Oncology	Oncology infusion nurses who administer the drug and perform patient monitoring.
`207P00000X`	Hematology/Oncology Nurse Practitioner	Advanced practice providers who may manage chemotherapy orders and administration.
`183500000X`	Pharmacist	Oncology pharmacists who compound, verify dosing, prepare, and document chemotherapeutic agents.

Related Diagnoses

ICD-10 Code	Description	Clinical Relevance
`C50.919`	Malignant neoplasm of unspecified site of unspecified female breast	Mitoxantrone may be used in treatment regimens for advanced or metastatic breast cancer.
`C92.00`	Acute myeloblastic leukemia not having achieved remission	Mitoxantrone is used in induction or salvage regimens for acute myeloid leukemia.
`C92.10`	Chronic myelomonocytic leukemia not having achieved remission	Hematologic malignancies treated with cytotoxic agents such as mitoxantrone.
`C83.90`	Non-Hodgkin lymphoma, unspecified, unspecified site	Certain lymphomas may be treated with anthracenediones like mitoxantrone in combination regimens.
`D61.9`	Aplastic anemia, unspecified	Supportive or adjunctive chemotherapy considerations and bone marrow suppression monitoring are relevant when administering mitoxantrone.

Related CPT Codes

CPT Code	Description	Relationship to This Procedure
`96413`	Chemotherapy administration, intravenous infusion technique; each additional hour (list separately in addition to code for initial hour)	May be reported when mitoxantrone infusion duration exceeds the time associated with the primary infusion code for the initial hour.
`96415`	Chemotherapy administration, intravenous, each additional sequential infusion of a new drug, up to one hour	Used when mitoxantrone is administered as an additional sequential infusion of a different chemotherapeutic agent during the same visit.
`96416`	Chemotherapy administration, intravenous, each additional sequential infusion of a new drug, each additional hour	Used for additional hours when combining multiple infusions including mitoxantrone.
`96365`	Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour	May be used when mitoxantrone is administered outside of chemotherapy-specific infusion codes and for initial infusion time.
`96366`	Intravenous infusion, each additional hour	Use when the infusion of mitoxantrone extends beyond the initial hour under non-chemotherapy-specific codes.
`36415`	Collection of venous blood by venipuncture	Commonly performed prior to mitoxantrone administration for required laboratory monitoring (CBC, chemistries).

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