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2025 HCPCS code J9205

J9205 represents 1 mg of irinotecan liposome injection, used in treating pancreatic adenocarcinoma.

Refer to HCPCS coding guidelines and payer-specific policies for precise billing and reimbursement information.Always confirm proper coding with the relevant payer.

Modifiers may apply depending on the circumstances of service. Consult appropriate modifier guidelines for specific scenarios.

Medical necessity for J9205 is established by a documented diagnosis of metastatic pancreatic adenocarcinoma, where the use of irinotecan liposome in combination with other therapies is considered a medically appropriate treatment option based on current clinical guidelines and evidence-based medicine.

Oncologists or other qualified healthcare providers administer the drug intravenously.The physician is responsible for ordering the medication, assessing the patient's response, and managing any adverse effects.

IMPORTANT:The administration of the drug would require a separate CPT code, such as 96413 (Chemotherapy administration, intravenous infusion technique, up to 1 hour, single or initial substance/drug).

In simple words: This code is for a cancer medicine called irinotecan liposome, given as a slow injection into a vein. It's used to treat a specific type of pancreatic cancer. The code only covers the cost of the medicine, not the injection itself.

HCPCS code J9205 designates 1 mg of irinotecan liposome injection.This antineoplastic agent is employed, often in conjunction with other medications, for the treatment of metastatic pancreatic adenocarcinoma.It functions by inhibiting the proliferation of cancerous cells. Administration is typically intravenous, via slow injection (exceeding 90 minutes).This code solely encompasses the drug itself; administration is billed separately.

Example 1: A 65-year-old male patient diagnosed with metastatic pancreatic adenocarcinoma receives 50 mg/m² of irinotecan liposome intravenously every 14 days in combination with fluorouracil and leucovorin as a first-line treatment., A 70-year-old female patient with pancreatic adenocarcinoma who progressed after gemcitabine-based therapy is treated with 70 mg/m² of irinotecan liposome intravenously every 14 days in combination with fluorouracil and leucovorin., A 58-year-old patient with metastatic pancreatic adenocarcinoma and a homozygous genotype for the UGT1A1*28 allele receives an initial dose of 50 mg/m² of irinotecan liposome intravenously every 14 days.The dosage may be increased to 70 mg/m² in subsequent cycles based on tolerance.

Complete patient demographics, diagnosis (ICD-10 codes),detailed treatment plan specifying the dose and frequency of irinotecan liposome administration,documentation of any pre-medications, concurrent medications, and monitoring parameters (e.g., complete blood count, liver function tests).Progress notes reflecting the patient's response to treatment, including any adverse events and management strategies are also required.

** Always verify coverage and reimbursement policies with the specific payer prior to billing.The brand name for this drug is Onivyde.

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