Summary & Overview
HCPCS J9326: Telisotuzumab Vedotin Injection, 1 mg
HCPCS Level II code J9326 denotes the injectable oncologic agent telisotuzumab vedotin-tllv, billed per 1 mg. As a recently introduced antibody-drug conjugate for targeted cancer therapy, this code enables providers and payers to identify drug-specific utilization and manage reimbursement for infusion-based administration. Nationally, accurate use of J9326 matters for claims processing, pharmacy billing, and tracking high-cost specialty oncology therapies.
Key payers covered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of the code's clinical context, typical sites of service, and the payer landscape. The publication presents benchmarks for utilization and reimbursement where available, outlines relevant policy considerations for coverage and prior authorization, and summarizes coding and billing nuances specific to high-cost oncologic injectables.
The report is intended for hospital billing offices, oncology practice administrators, revenue cycle professionals, and policy analysts seeking a concise reference on J9326. Data not available in the input is noted where applicable; the content focuses on the code definition, clinical setting, and payer coverage considerations at a national level.
Billing Code Overview
HCPCS Level II code J9326 represents an injection of telisotuzumab vedotin-tllv, billed per 1 mg of drug. This code is used to report administration of the specified antibody-drug conjugate formulation.
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Service type: Drug administration (intravenous oncologic therapeutic agent)
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Typical site of service: Hospital outpatient department or ambulatory infusion center
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced or metastatic non–small cell lung cancer (NSCLC) whose tumor tests positive for MET exon 14 skipping mutation or MET amplification and who is receiving targeted antibody–drug conjugate therapy. The patient presents to an outpatient oncology infusion center for administration of J9326 (telisotuzumab vedotin-tllv) as ordered by the medical oncologist. The clinical workflow includes pre-infusion nursing assessment (vitals, review of labs such as CBC and liver function tests), verification of the prescription and dose by pharmacy, preparation of the intravenous infusion in an appropriate admixture, and time-out verification of patient identity and consent. During infusion, nursing monitors for infusion reactions, neuropathy, hematologic toxicity, and other adverse events. Post-infusion, the patient is observed for a defined period, given discharge instructions about potential side effects (e.g., peripheral neuropathy, fatigue), and scheduled for follow-up oncology visits and labs to assess response and toxicity. Billing for the drug is submitted using HCPCS Level II code J9326 with supportive documentation of diagnosis, dose administered, lot numbers, and infusion date.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/not administered to any patient |