Summary & Overview
HCPCS Level II J9313: Injection, moxetumomab pasudotox-tdfk, 0.01 mg
HCPCS Level II code J9313 denotes an injectable biologic: moxetumomab pasudotox-tdfk, billed per 0.01 mg. This specialty oncology drug billing code matters nationally because it captures dosing-based reimbursement for a high-cost, targeted therapeutic administered in infusion settings. Accurate use of J9313 affects claims processing, drug utilization tracking, and payer coverage determinations across commercial and government programs.
Key payers in scope include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a compact briefing on the clinical context for moxetumomab pasudotox-tdfk, expectations for typical sites of care, and what to look for in payer coverage policies. The publication summarizes common billing considerations, outlines benchmarks for billing unitization, and flags areas where policy language often drives prior authorization and medical necessity reviews.
This analysis is written for a national audience and aims to help revenue cycle managers, oncology clinic administrators, and policy analysts understand how J9313 is used on claims, which stakeholders commonly review such claims, and which elements to verify when preparing submissions. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J9313 represents an injection of moxetumomab pasudotox-tdfk, measured per 0.01 mg. This drug is an engineered immunotoxin used for targeted treatment in oncology settings.
Service type: Therapeutic injection/infusion of a biologic agent
Typical site of service: Hospital outpatient infusion center or oncology clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with relapsed or refractory hairy cell leukemia who is scheduled to receive targeted immunotoxin therapy with moxetumomab pasudotox-tdfk (J9313). The clinical workflow begins with hematology/oncology evaluation confirming indication and documenting prior therapies, disease status, and organ function. Pre-infusion orders include baseline vital signs, complete blood count, comprehensive metabolic panel, and assessment for infusion-related risk factors. The medication is supplied in measured units; billing reports units in increments of 0.01 mg per J9313 unit. On the day of service the patient presents to an outpatient infusion center or hospital outpatient department; nursing verifies identity, consent, and allergy history, establishes intravenous access, and performs pre-medication per protocol. The drug is prepared by pharmacy under sterile conditions; dose verification and independent double-checks occur prior to administration. During infusion, the patient is monitored for hypotension, capillary leak, infusion reactions, and other adverse events; vital signs and toxicity assessments are documented. Post-infusion observation and discharge instructions are provided; any infusion-related complications are coded and reported. Typical sites of service include an outpatient infusion center, hospital outpatient department, or specialized oncology clinic. Common modifiers may be appended to reflect service details such as physician coordination (11), unusual procedural services (22), or bilateral/multiple site adjustments where applicable, per payer rules.
Coding Specifications
| Modifier |
|---|