J9204 HCPCS code: Injection, mogamulizumab-kpkc, 1 mg
J9204 is the HCPCS Level II code for injection, mogamulizumab-kpkc, 1 mg. In 2024 Medicare paid an average of $185.04 per service for J9204 across 85,473 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 160 per day on outpatient hospital claims. In 2024, about 242 clinicians billed Medicare for J9204 for 94 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 | 2019-10-01 |
| Last action effective | 2019-10-01 |
Who bills J9204 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 242 |
| Medicare beneficiaries | 94 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9204, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 85,993 | 87 | $211.15 | $168.57 |
| 2023 | 80,999 | 91 | $217.06 | $172.93 |
| 2024 | 85,473 | 94 | $232.26 | $185.04 |
States with the most J9204 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 12,325 | $185.26 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 160 | Prescribing Information |
| practitioner claims | 160 | Prescribing Information |
What changed for J9204
- 2019-10-01: J9204 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 J9204?
J9204 is the HCPCS Level II code for injection, mogamulizumab-kpkc, 1 mg. Short descriptor: "Inj mogamulizumab-kpkc, 1 mg".
How much does Medicare pay for J9204?
In 2024, the average Medicare payment was $185.04 per service (average allowed $232.26).
Does Medicare cover J9204?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9204 can be billed per day?
160 on outpatient hospital claims; 160 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
- J9200 — Injection, floxuridine, 500 mg
- J9201 — Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
- J9202 — Goserelin acetate implant, per 3.6 mg
- J9203 — Injection, gemtuzumab ozogamicin, 0.1 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 J9204
- Watch J9204 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9204
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.