Market Access / Coding

Coding & Reimbursement

HCPCS J-codes and reimbursement rates for oncology therapies administered at Mays Cancer Center. Includes active commercial products and investigational agents.

Total Codes

Active / Commercial

Investigational

J-Code Directory

HCPCS codes and ASP-based reimbursement for oncology therapies

J-Code	Drug	Indication	Unit	ASP Rate	Route	Status
`A9607`	Pluvicto (Lu-177 vipivotide tetraxetan) Pluvicto	mCRPC (PSMA+)	1 mCi	$42,500 per dose	IV infusion	Active
`A9593`	Ga-68 PSMA-11 Diagnostic (Pluvicto companion)	PSMA PET imaging	1 mCi	$3,200 per scan	IV injection	Active
`J9317`	Sacituzumab govitecan-hziy (Trodelvy) Sacituzumab Govitecan	mTNBC, mUC (approved); rGBM (investigational)	2.5 mg	$2,094.84 per 2.5mg	IV infusion	Active
`C9399`	DT2216 (investigational) DT2216	Relapsed/refractory hematologic malignancies	N/A — investigational	N/A — clinical trial	IV infusion	Investigational
`C9399`	BSI-082 (investigational) BSI-082	Advanced solid tumors	N/A — investigational	N/A — clinical trial	IV infusion	Investigational
`J9271`	Pembrolizumab (Keytruda) Combination partner	Multiple solid tumors	1 mg	$51.22 per mg	IV infusion	Active
`J9173`	Durvalumab (Imfinzi) Combination partner	NSCLC, BTC, HCC	10 mg	$32.68 per 10mg	IV infusion	Active
`J9299`	Nivolumab (Opdivo) Combination partner	Multiple solid tumors	1 mg	$32.46 per mg	IV infusion	Active

Reimbursement Notes

Key considerations for oncology drug reimbursement at Mays

Buy-and-Bill Model

Most oncology drugs at Mays are administered via the buy-and-bill model. The hospital purchases the drug, administers it to the patient, and is reimbursed at ASP + 6% for Medicare Part B. Margin optimization depends on 340B eligibility and GPO contract pricing.

340B Program

As an NCI-designated cancer center with DSH adjustment, Mays Cancer Center is eligible for 340B pricing on most outpatient drugs. This creates significant margin between acquisition cost and Medicare reimbursement, supporting the mission of care for underserved populations.

Investigational Drug Billing

Investigational agents (DT2216, BSI-082) use the unclassified code C9399. Routine care costs associated with qualifying clinical trials are covered by Medicare under the Clinical Trial Policy (NCD 310.1). Investigational drugs are provided by the sponsor at no cost to the patient.

Radioligand Therapy Logistics

Pluvicto requires specialized nuclear pharmacy handling, dose-specific ordering (no inventory stocking), and radiation safety protocols. The short half-life of Lu-177 (6.7 days) requires precise scheduling of patient appointments with dose delivery logistics.