Summary & Overview
HCPCS J9361: Injection, efbemalenograstim alfa-vuxw, 0.5 mg
HCPCS Level II code J9361 designates a 0.5 mg dose of efbemalenograstim alfa-vuxw for injection, a hematologic growth factor used to stimulate neutrophil recovery. This code matters nationally as biologic and biosimilar injectable supportive therapies represent a significant component of oncology and hematology outpatient drug spend and care pathways. Accurate coding affects coverage, billing, and reporting for clinicians and institutions administering these agents.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. The publication provides a national overview of coding and billing context for J9361, summarizes payer coverage patterns where available, and outlines the clinical role of efbemalenograstim alfa-vuxw in supportive care. Readers will find benchmarks for billing unitization and site-of-service considerations, updates on policy and coverage trends affecting injectable growth factors, and clinical context regarding typical use in outpatient infusion settings.
Data not available in the input for payer-specific fee schedules, diagnosis coding pairs, and provider taxonomy mappings.
Billing Code Overview
HCPCS Level II code J9361 represents an injection of efbemalenograstim alfa-vuxw, dosed per 0.5 mg. This code describes the pharmaceutical product and unit of measure for administration of a synthetic or biosimilar granulocyte colony-stimulating factor used to stimulate neutrophil production.
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Service type: Injection — supportive care / hematologic growth factor
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Typical site of service: Outpatient infusion clinic, physician office, or hospital outpatient department
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult receiving supportive care for chemotherapy-induced neutropenia or a patient with chronic neutropenia requiring prophylactic granulocyte support. The medication J9361 (injection, efbemalenograstim alfa-vuxw, 0.5 mg) is administered as a subcutaneous injection in an outpatient oncology infusion suite or a hospital outpatient clinic. The clinical workflow includes medication order verification by the prescribing oncologist or hematologist, pharmacist compounding/verification, nursing pre‑assessment (vital signs, review of allergy history, platelet counts and absolute neutrophil count), informed consent for supportive therapy, subcutaneous administration, post‑injection observation for immediate adverse reactions (typically 15–30 minutes), documentation of lot and expiration numbers, and scheduling of follow‑up laboratory testing and subsequent doses as indicated by the oncology treatment plan.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | No modifier | Use when no unusual circumstances apply and standard billing for the drug is appropriate. |
22 |