J9223 — Injection, lurbinectedin, 0.1 mg
J9223 is a HCPCS Level II code for injection, lurbinectedin, 0.1 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Carrier judgment
Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J9223 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 120 units MAI 3 — Date of Service Edit: Clinical · CMS Policy
- outpatient
- 120 units MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J9223
- Long descriptor
- Injection, lurbinectedin, 0.1 mg
- Short descriptor
- Inj. lurbinectedin, 0.1 mg
- Added
- January 1, 2021
- BETOS
- O1D
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J9223
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J9223 is not quite right, the correct code is very often within a few positions of it.
- J9213Injection, interferon, alfa-2a, recombinant, 3 million units
- J9214Injection, interferon, alfa-2b, recombinant, 1 million units
- J9215Injection, interferon, alfa-n3, (human leukocyte derived), 250,000 iu
- J9216Injection, interferon, gamma 1-b, 3 million units
- J9217Leuprolide acetate (for depot suspension), 7.5 mg
- J9218Leuprolide acetate, per 1 mg
- J9219Leuprolide acetate implant, 65 mg
- J9220Injection, indigotindisulfonate sodium, 1 mg
- J9225Histrelin implant (vantas), 50 mg
- J9226Histrelin implant (supprelin la), 50 mg
- J9227Injection, isatuximab-irfc, 10 mg
- J9228Injection, ipilimumab, 1 mg
- J9229Injection, inotuzumab ozogamicin, 0.1 mg
- J9230Injection, mechlorethamine hydrochloride, (nitrogen mustard), 10 mg
- J9232Injection, docetaxel (hospira), not therapeutically equivalent to j9171, 1 mg
- J9245Injection, melphalan hydrochloride, not otherwise specified, 50 mg
Questions about J9223
What is HCPCS code J9223?
J9223 is a HCPCS Level II code for injection, lurbinectedin, 0.1 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J9223?
The CMS HCPCS file marks J9223 as "Carrier judgment". Coverage is decided by your Medicare contractor, not by national policy. Whether this is paid depends on the LCD for your jurisdiction and on what the documentation supports.
How is J9223 paid under the physician fee schedule?
J9223 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).