J9201 HCPCS code: Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
J9201 is the HCPCS Level II code for injection, gemcitabine hydrochloride, not otherwise specified, 200 mg. In 2024 Medicare paid an average of $2.58 per service for J9201 across 581,823 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 20 per day on outpatient hospital claims. Medicare volume fell 25% from 2022 to 2024 (775,386 to 581,823 services). In 2024, about 5,811 clinicians billed Medicare for J9201 for 12,509 beneficiaries; California, Florida, Texas accounted for 33% 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 | 1998-01-01 |
| Last action effective | 2020-01-01 |
Who bills J9201 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 5,811 |
| Medicare beneficiaries | 12,509 |
| States with claims | 47 |
| Share of services in top 3 states (California, Florida, Texas) | 33% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9201, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 775,386 | 14,946 | $3.75 | $2.96 |
| 2023 | 694,318 | 14,420 | $3.52 | $2.77 |
| 2024 | 581,823 | 12,509 | $3.29 | $2.58 |
States with the most J9201 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 69,886 | $2.62 |
| Florida | 62,289 | $2.67 |
| Texas | 61,702 | $2.58 |
| New York | 32,458 | $2.49 |
| Illinois | 26,063 | $2.61 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 20 | Prescribing Information |
| practitioner claims | 20 | Prescribing Information |
What changed for J9201
- 1998-01-01: J9201 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 J9201?
J9201 is the HCPCS Level II code for injection, gemcitabine hydrochloride, not otherwise specified, 200 mg. Short descriptor: "In gemcitabine hcl nos 200mg".
How much does Medicare pay for J9201?
In 2024, the average Medicare payment was $2.58 per service (average allowed $3.29).
Does Medicare cover J9201?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9201 can be billed per day?
20 on outpatient hospital claims; 20 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
- J9200 — Injection, floxuridine, 500 mg
- J9202 — Goserelin acetate implant, per 3.6 mg
- J9203 — Injection, gemtuzumab ozogamicin, 0.1 mg
- J9204 — Injection, mogamulizumab-kpkc, 1 mg
- J9205 — Injection, irinotecan liposome, 1 mg
- J9206 — Injection, irinotecan, 20 mg
- J9207 — Injection, ixabepilone, 1 mg
- J9208 — Injection, ifosfamide, 1 gram
- J9209 — Injection, mesna, 200 mg
- J9210 — Injection, emapalumab-lzsg, 1 mg
- J9211 — Injection, idarubicin hydrochloride, 5 mg
- J9212 — Injection, interferon alfacon-1, recombinant, 1 microgram
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Next steps
- Run a reimbursement report for a device billed under J9201
- Watch J9201 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9201
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.