HCPCS Code Details - J9196

HCPCS Level II Code
Drugs administered other than oral method, chemotherapy drugs
HCPCS Code J9196
Description

Long description:
Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg

Short description:
Inj gemcitabine hcl (accord)

HCPCS Modifier1
HCPCS Pricing indicator 51 - Drugs
Multiple pricing indicator A - Not applicable as HCPCS priced under one methodology
Coverage code D - Special coverage instructions apply
ASC payment group code Effective Jan 01, 2024 - This procedure is approved to be performed in an ambulatory surgical center.
BETOS2 code O1D - Chemotherapy
HCPCS Action code P - Payment change (MOG, pricing indicator codes, anesthesia base units,Ambulatory Surgical Centers)
Type of service 1 - Medical care
Effective date Effective Jan 01, 2024
Date added Added Apr 01, 2023
HCPCS Coding Procedures

HCPCS Modifiers

In HCPCS Level II, modifiers are composed of two alpha or alphanumeric characters.

Example: E0260-NU - Hospital bed, semi-electric (head and foot adjustment), with any type side rails, with mattress
NU” identifies the hospital bed as new equipment

ASP Drug pricing - J9196

Effective Code Dosage Payment
Limit
Vaccine AWP % Vaccine Limit Infusion AWP % DME infusion limit Blood AWP % Blood limit Clotting factor Note
January 1, 2024 - March 31, 2024 200 MG 8.775 - - - - - -
October 1, 2023 - December 31, 2023 200 MG 3.689 20% - - - - -
Jul 1, 2023 - Sep 30, 2023 200 MG 3.715 20% - - - - -
April 1, 2023 - June 30, 2023 200 MG 3.853 20% - - - - -

See also

  • HCPCS J9190 · Injection, fluorouracil, 500 mg

  • HCPCS J9198 · Injection, gemcitabine hydrochloride, (infugem), 100 mg

  • HCPCS J9199 · Injection, gemcitabine hydrochloride (infugem), 200 mg

  • HCPCS J9201 · Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg


1 Two-digit numeric codes are Level I code modifiers copyrighted© by the American Medical Association's Current Procedural Terminology (CPT).

2 BETOS stands for “Berenson-Eggers Type Of Service”