J9196 HCPCS code: Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg
J9196 is the HCPCS Level II code for injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg. In 2024 Medicare paid an average of $6.09 per service for J9196 across 137,751 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 19 per day on outpatient hospital claims. Medicare volume rose 137% from 2023 to 2024 (58,011 to 137,751 services). In 2024, about 1,433 clinicians billed Medicare for J9196 for 3,082 beneficiaries; Florida, Virginia, California accounted for 38% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2023-04-01 |
| Last action effective | 2024-01-01 |
Who bills J9196 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,433 |
| Medicare beneficiaries | 3,082 |
| States with claims | 33 |
| Share of services in top 3 states (Florida, Virginia, California) | 38% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9196, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 58,011 | 1,515 | $3.70 | $2.95 |
| 2024 | 137,751 | 3,082 | $7.02 | $6.09 |
States with the most J9196 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 30,743 | $6.34 |
| Virginia | 10,866 | $5.66 |
| California | 10,112 | $6.37 |
| Texas | 9,342 | $5.87 |
| Illinois | 9,292 | $6.58 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 19 | CMS Policy |
| practitioner claims | 19 | CMS Policy |
What changed for J9196
- 2023-04-01: J9196 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J9196?
J9196 is the HCPCS Level II code for injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg. Short descriptor: "Inj gemcitabine hcl (accord)".
How much does Medicare pay for J9196?
In 2024, the average Medicare payment was $6.09 per service (average allowed $7.02).
Does Medicare cover J9196?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9196 can be billed per day?
19 on outpatient hospital claims; 19 on practitioner claims (NCCI medically unlikely edits).
Related J91 codes
- J9100 — Injection, cytarabine, 100 mg
- J9118 — Injection, calaspargase pegol-mknl, 10 units
- J9119 — Injection, cemiplimab-rwlc, 1 mg
- J9120 — Injection, dactinomycin, 0.5 mg
- J9130 — Dacarbazine, 100 mg
- J9144 — Injection, daratumumab, 10 mg and hyaluronidase-fihj
- J9145 — Injection, daratumumab, 10 mg
- J9150 — Injection, daunorubicin, 10 mg
- J9151 — Injection, daunorubicin citrate, liposomal formulation, 10 mg
- J9153 — Injection, liposomal, 1 mg daunorubicin and 2.27 mg cytarabine
- J9155 — Injection, degarelix, 1 mg
- J9160 — Injection, denileukin diftitox, 300 micrograms
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Next steps
- Run a reimbursement report for a device billed under J9196
- Watch J9196 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9196
Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.