J9206 HCPCS code: Injection, irinotecan, 20 mg
J9206 is the HCPCS Level II code for injection, irinotecan, 20 mg. In 2024 Medicare paid an average of $2.06 per service for J9206 across 631,049 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 42 per day on outpatient hospital claims. Medicare volume fell 8% from 2022 to 2024 (686,710 to 631,049 services). In 2024, about 3,636 clinicians billed Medicare for J9206 for 7,019 beneficiaries; Texas, Florida, California accounted for 35% 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 | 2009-01-01 |
Who bills J9206 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,636 |
| Medicare beneficiaries | 7,019 |
| States with claims | 45 |
| Share of services in top 3 states (Texas, Florida, California) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9206, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 686,710 | 7,492 | $2.37 | $1.89 |
| 2023 | 653,244 | 7,173 | $2.34 | $1.86 |
| 2024 | 631,049 | 7,019 | $2.59 | $2.06 |
States with the most J9206 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 81,340 | $2.08 |
| Florida | 73,613 | $2.07 |
| California | 65,391 | $2.08 |
| Illinois | 37,083 | $2.07 |
| New York | 27,416 | $1.92 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 42 | Prescribing Information |
| practitioner claims | 42 | Prescribing Information |
What changed for J9206
- 1998-01-01: J9206 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 J9206?
J9206 is the HCPCS Level II code for injection, irinotecan, 20 mg. Short descriptor: "Irinotecan injection".
How much does Medicare pay for J9206?
In 2024, the average Medicare payment was $2.06 per service (average allowed $2.59).
Does Medicare cover J9206?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9206 can be billed per day?
42 on outpatient hospital claims; 42 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
- J9205 — Injection, irinotecan liposome, 1 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 J9206
- Watch J9206 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9206
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.