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2025 HCPCS code J9206

Injection, irinotecan, 20 mg

For providers other than home infusion therapy or pharmacy, reimbursement for J9206 may be limited to 22 units per date of service when billed with a diagnosis of Ewing sarcoma or pediatric solid tumors. Always check payer-specific guidelines.

Modifiers may be applicable depending on the specific circumstances of the administration. Refer to current HCPCS modifier guidelines for details.

Medical necessity for J9206 must be supported by the patient's diagnosis and treatment plan. The use of irinotecan should be consistent with established guidelines for cancer treatment.

IMPORTANT:For irinotecan liposome, use J9205. Z79.634 (long term use of topoisomerase inhibitor) or Z79.64 (long term use of myelosuppressive agent) can be used as ICD-10-CM diagnosis codes.

In simple words: This code refers to a cancer medication called irinotecan, given by injection, with each unit representing 20 milligrams of the drug.

Irinotecan is a chemotherapy drug used to treat various types of cancer. This HCPCS code represents 20 mg of irinotecan administered via injection.

Example 1: A patient with metastatic colorectal cancer receives 180 mg/m2 of irinotecan intravenously every two weeks as part of the FOLFIRI regimen., A child with Ewing sarcoma receives 20 mg/m2/day of irinotecan IV for 10 days of a 21-28 day cycle in combination with temozolomide and vincristine., A patient with pancreatic adenocarcinoma receives irinotecan as part of the FOLFIRINOX regimen, up to 180mg/m2 IV every 2 weeks.

Documentation should include the diagnosis, dosage, route of administration, and medical necessity for the use of irinotecan. Supporting clinical documentation such as pathology reports and treatment plans should also be maintained.

** This code represents the drug irinotecan only, and not its administration. Separate codes may be required for drug administration services. Brand name Camptosar®. Always verify coding guidelines and payer policies for the most up-to-date information as of December 10, 2024.

** Only Enterprise users with EHR integration can access case-specific answers. Click here to request access.

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