J9198 HCPCS code: Injection, gemcitabine hydrochloride, (infugem), 100 mg
J9198 is the HCPCS Level II code for injection, gemcitabine hydrochloride, (infugem), 100 mg. In 2024 Medicare paid an average of $28.97 per service for J9198 across 708 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 38 per day on outpatient hospital claims. Medicare volume fell 86% from 2022 to 2024 (4,899 to 708 services). In 2024, about 12 clinicians billed Medicare for J9198 for 49 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2020-07-01 |
| Last action effective | 2021-01-01 |
Who bills J9198 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 12 |
| Medicare beneficiaries | 49 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9198, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 4,899 | 71 | $24.59 | $19.51 |
| 2023 | 1,147 | 45 | $29.33 | $23.39 |
| 2024 | 708 | 49 | $36.99 | $28.97 |
States with the most J9198 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| New York | 260 | $31.58 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 38 | CMS Policy |
| practitioner claims | 38 | CMS Policy |
What changed for J9198
- 2020-07-01: J9198 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 J9198?
J9198 is the HCPCS Level II code for injection, gemcitabine hydrochloride, (infugem), 100 mg. Short descriptor: "Inj. infugem, 100 mg".
How much does Medicare pay for J9198?
In 2024, the average Medicare payment was $28.97 per service (average allowed $36.99).
Does Medicare cover J9198?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9198 can be billed per day?
38 on outpatient hospital claims; 38 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 J9198
- Watch J9198 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9198
Sources: CMS HCPCS Level II release October 2026; 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.