J9225 HCPCS code: Histrelin implant (vantas), 50 mg
J9225 is the HCPCS Level II code for histrelin implant (vantas), 50 mg. 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 1 per day on outpatient hospital claims.
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 | 2006-01-01 |
| Last action effective | 2008-01-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Prescribing Information |
| practitioner claims | 1 | Prescribing Information |
Medicare policy articles for this code
- A52453: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (Wellpoint Federal (MAC - Part A, MAC - Part B))
- A59160: Billing and Coding: Luteinizing Hormone-Releasing Hormone (LHRH) Analogs (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (246 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C08.0 | Malignant neoplasm of submandibular gland | 2 |
| C08.1 | Malignant neoplasm of sublingual gland | 2 |
| C48.1 | Malignant neoplasm of specified parts of peritoneum | 2 |
| C48.8 | Malignant neoplasm of overlapping sites of retroperitoneum and peritoneum | 2 |
| C50.011 | Malignant neoplasm of nipple and areola, right female breast | 2 |
| C50.012 | Malignant neoplasm of nipple and areola, left female breast | 2 |
| C50.021 | Malignant neoplasm of nipple and areola, right male breast | 2 |
| C50.022 | Malignant neoplasm of nipple and areola, left male breast | 2 |
| C50.111 | Malignant neoplasm of central portion of right female breast | 2 |
| C50.112 | Malignant neoplasm of central portion of left female breast | 2 |
Showing 10 of 246. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J9225
- 2006-01-01: J9225 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 J9225?
J9225 is the HCPCS Level II code for histrelin implant (vantas), 50 mg. Short descriptor: "Vantas implant".
Does Medicare cover J9225?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J9225?
Medicare policy articles that cite J9225 list 246 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include C08.0 (Malignant neoplasm of submandibular gland), C08.1 (Malignant neoplasm of sublingual gland), C48.1 (Malignant neoplasm of specified parts of peritoneum). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J9225 can be billed per day?
1 on outpatient hospital claims; 1 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
- 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J9225
- Watch J9225 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9225
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.