2025 HCPCS code J9063

Injection, mirvetuximab soravtansine-gynx, 1 mg. This code represents 1 mg of mirvetuximab soravtansine–gynx, administered intravenously to treat ovarian, fallopian tube, or primary peritoneal cancer.

Report J9063 for each 1 mg of mirvetuximab soravtansine-gynx administered. Modifier JW may be applicable for discarded portions of a single-dose vial, per payer guidelines.

Applicable modifiers may include JW for wasted drug amount.

Medical necessity must be established through documentation confirming FRα-positive ovarian, fallopian tube, or primary peritoneal cancer, meeting specific criteria outlined in clinical guidelines and payer policies.

Administered by healthcare providers, typically oncologists, in settings equipped for intravenous infusions and managing potential side effects.Accurate dosage calculation based on the patient's ideal body weight is crucial. Patient monitoring for adverse reactions during and after administration is essential.

In simple words: This code covers the cost of 1 milligram of Elahere, a medication used to treat certain types of ovarian, fallopian tube, and peritoneal cancers. It's given through an IV.

Mirvetuximab soravtansine-gynx is an antibody-drug conjugate (ADC) that targets folate receptor alpha (FRα), a protein overexpressed in many ovarian cancers.The drug binds to FRα on the cancer cell surface, and is internalized, releasing a cytotoxic agent that disrupts cell division and leads to cell death. The dosage is calculated based on the patient's ideal body weight and administered intravenously. This HCPCS code J9063 is reported per 1 mg of the drug.

Example 1: A patient with FRα-positive advanced ovarian cancer receives 6 mg/kg of mirvetuximab soravtansine-gynx based on their ideal body weight., A patient with recurrent fallopian tube cancer, confirmed to overexpress FRα, is treated with mirvetuximab soravtansine-gynx., A patient with primary peritoneal cancer receives mirvetuximab soravtansine-gynx after prior chemotherapy regimens.

Documentation should include the patient's diagnosis, FRα status, ideal body weight, dose administered, date and time of administration, infusion details, and any adverse reactions.

** Brand name: Elahere.Refer to payer-specific guidelines for coverage and reimbursement policies.

  • Payment Status: Active
  • Specialties:Oncology, Gynecologic Oncology
  • Place of Service:Office, Inpatient Hospital, Outpatient Hospital, Clinic
** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.