J9203 HCPCS code: Injection, gemtuzumab ozogamicin, 0.1 mg
J9203 is the HCPCS Level II code for injection, gemtuzumab ozogamicin, 0.1 mg. In 2024 Medicare paid an average of $178.87 per service for J9203 across 3,901 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 180 per day on outpatient hospital claims. Medicare volume rose 4% from 2022 to 2024 (3,766 to 3,901 services). In 2024, about 40 clinicians billed Medicare for J9203 for 27 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 | 2018-01-01 |
| Last action effective | 2018-01-01 |
Who bills J9203 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 40 |
| Medicare beneficiaries | 27 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9203, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,766 | 27 | $210.29 | $167.77 |
| 2023 | 3,150 | 22 | $215.71 | $171.86 |
| 2024 | 3,901 | 27 | $224.50 | $178.87 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 180 | Prescribing Information |
| practitioner claims | 180 | Prescribing Information |
What changed for J9203
- 2018-01-01: J9203 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 J9203?
J9203 is the HCPCS Level II code for injection, gemtuzumab ozogamicin, 0.1 mg. Short descriptor: "Gemtuzumab ozogamicin 0.1 mg".
How much does Medicare pay for J9203?
In 2024, the average Medicare payment was $178.87 per service (average allowed $224.50).
Does Medicare cover J9203?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9203 can be billed per day?
180 on outpatient hospital claims; 180 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
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Next steps
- Run a reimbursement report for a device billed under J9203
- Watch J9203 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9203
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.