J9227 HCPCS code: Injection, isatuximab-irfc, 10 mg
J9227 is the HCPCS Level II code for injection, isatuximab-irfc, 10 mg. In 2024 Medicare paid an average of $59.65 per service for J9227 across 432,877 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 150 per day on outpatient hospital claims. Medicare volume rose 44% from 2022 to 2024 (301,115 to 432,877 services). In 2024, about 819 clinicians billed Medicare for J9227 for 549 beneficiaries; California, Texas, Florida accounted for 50% of services.
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 | 2020-10-01 |
| Last action effective | 2020-10-01 |
Who bills J9227 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 819 |
| Medicare beneficiaries | 549 |
| States with claims | 15 |
| Share of services in top 3 states (California, Texas, Florida) | 50% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9227, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 301,115 | 389 | $67.27 | $53.72 |
| 2023 | 360,765 | 449 | $70.07 | $55.83 |
| 2024 | 432,877 | 549 | $74.87 | $59.65 |
States with the most J9227 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 69,294 | $59.24 |
| Texas | 54,291 | $60.60 |
| Florida | 45,917 | $60.48 |
| Arizona | 27,570 | $54.09 |
| New York | 24,289 | $58.89 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
What changed for J9227
- 2020-10-01: J9227 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 J9227?
J9227 is the HCPCS Level II code for injection, isatuximab-irfc, 10 mg. Short descriptor: "Inj. isatuximab-irfc 10 mg".
How much does Medicare pay for J9227?
In 2024, the average Medicare payment was $59.65 per service (average allowed $74.87).
Does Medicare cover J9227?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9227 can be billed per day?
150 on outpatient hospital claims; 150 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
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Next steps
- Run a reimbursement report for a device billed under J9227
- Watch J9227 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9227
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.