Summary & Overview
HCPCS J9347: Injection, tremelimumab-actl, 1 mg
HCPCS Level II code J9347 denotes a 1 mg unit of tremelimumab-actl, a monoclonal antibody administered by injection for oncology indications. As a specific drug J-code, J9347 is used on medical claims to itemize the quantity of drug supplied for infusion or injection and is essential for accurate drug utilization tracking and payment for infused biologic therapies nationwide.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for tremelimumab-actl, how the HCPCS drug J-code functions in medical billing, and what payers typically require for coverage documentation. The publication summarizes common billing considerations, places the drug within infusion service lines, and outlines which service settings most frequently bill this code.
This summary is intended to inform billing managers, revenue cycle teams, and policy analysts about the role of J9347 in claims, typical sites of service for administration, and the payer landscape relevant to reimbursement and prior authorization practices. Data not available in the input is noted where specific payer policies or utilization benchmarks would normally appear.
Billing Code Overview
HCPCS Level II code J9347 describes injection, tremelimumab-actl, 1 mg. This code represents administration of the monoclonal antibody tremelimumab-actl formulated for parenteral injection, with the billing unit defined per 1 mg of drug product.
Service type: Therapeutic drug injection
Typical site of service: Hospital outpatient infusion center or physician office infusion suite
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced or metastatic cancer for which immune checkpoint inhibition is indicated, receiving intravenous tremelimumab-actl as part of monotherapy or combination immunotherapy in an oncology infusion clinic or hospital outpatient infusion center. The patient arrives for a scheduled infusion, undergoes pre-infusion nursing assessment (vital signs, symptom review, medication reconciliation, allergy check), and baseline laboratory review (complete blood count, comprehensive metabolic panel, liver function tests). The oncology pharmacist verifies the J9347 drug dose (reported per mg), prepares the infusion per aseptic technique, and labels with appropriate lot/expiration information. The patient is connected to an IV pump, monitored during the infusion for infusion-related reactions and immune-mediated adverse events, and observed for a post-infusion period per institutional protocol. Documentation includes indication, dose in milligrams, lot number, route (intravenous), infusion start/stop times, patient tolerance, and any administered premedications or supportive care. Billing uses J9347 reported in milligrams, with appropriate modifier(s) to reflect circumstances such as bilateral procedures, discontinued therapy, or drug waste reporting when applicable.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered to patient |