J9272 HCPCS code: Injection, dostarlimab-gxly, 10 mg
J9272 is the HCPCS Level II code for injection, dostarlimab-gxly, 10 mg. In 2024 Medicare paid an average of $183.80 per service for J9272 across 177,188 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 100 per day on outpatient hospital claims. Medicare volume rose 3374% from 2022 to 2024 (5,101 to 177,188 services). In 2024, about 722 clinicians billed Medicare for J9272 for 545 beneficiaries; Texas, Florida, California accounted for 52% 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 | 2022-01-01 |
| Last action effective | 2022-01-01 |
Who bills J9272 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 722 |
| Medicare beneficiaries | 545 |
| States with claims | 15 |
| Share of services in top 3 states (Texas, Florida, California) | 52% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9272, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 5,101 | 25 | $216.65 | $172.68 |
| 2023 | 41,465 | 171 | $222.28 | $177.09 |
| 2024 | 177,188 | 545 | $230.70 | $183.80 |
States with the most J9272 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 36,150 | $183.30 |
| Florida | 28,300 | $183.22 |
| California | 8,900 | $183.94 |
| Illinois | 8,700 | $184.26 |
| Arizona | 8,450 | $183.73 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 100 | Prescribing Information |
| practitioner claims | 100 | Prescribing Information |
What changed for J9272
- 2022-01-01: J9272 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 J9272?
J9272 is the HCPCS Level II code for injection, dostarlimab-gxly, 10 mg. Short descriptor: "Inj, dostarlimab-gxly, 10 mg".
How much does Medicare pay for J9272?
In 2024, the average Medicare payment was $183.80 per service (average allowed $230.70).
Does Medicare cover J9272?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9272 can be billed per day?
100 on outpatient hospital claims; 100 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
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- 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
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- J9210 — Injection, emapalumab-lzsg, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J9272
- Watch J9272 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9272
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.