J9205 HCPCS code: Injection, irinotecan liposome, 1 mg
J9205 is the HCPCS Level II code for injection, irinotecan liposome, 1 mg. In 2024 Medicare paid an average of $48.96 per service for J9205 across 480,140 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 215 per day on outpatient hospital claims. Medicare volume rose 20% from 2022 to 2024 (398,804 to 480,140 services). In 2024, about 947 clinicians billed Medicare for J9205 for 742 beneficiaries; Florida, California, Illinois accounted for 47% 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 | 2017-01-01 |
| Last action effective | 2017-01-01 |
Who bills J9205 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 947 |
| Medicare beneficiaries | 742 |
| States with claims | 19 |
| Share of services in top 3 states (Florida, California, Illinois) | 47% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9205, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 398,804 | 599 | $57.06 | $45.58 |
| 2023 | 430,028 | 655 | $59.41 | $47.33 |
| 2024 | 480,140 | 742 | $61.45 | $48.96 |
States with the most J9205 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 85,253 | $49.73 |
| California | 70,186 | $49.70 |
| Illinois | 26,789 | $49.73 |
| Texas | 23,392 | $49.70 |
| New York | 20,577 | $47.55 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 215 | CMS Policy |
| practitioner claims | 215 | CMS Policy |
What changed for J9205
- 2017-01-01: J9205 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 J9205?
J9205 is the HCPCS Level II code for injection, irinotecan liposome, 1 mg. Short descriptor: "Inj irinotecan liposome 1 mg".
How much does Medicare pay for J9205?
In 2024, the average Medicare payment was $48.96 per service (average allowed $61.45).
Does Medicare cover J9205?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9205 can be billed per day?
215 on outpatient hospital claims; 215 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
- J9204 — Injection, mogamulizumab-kpkc, 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 J9205
- Watch J9205 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9205
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.