HCPCS code J9191: Avyxa fluorouracil, per 10 mg2026 Medicare rate & RVUs in Maine
Identifies Avyxa fluorouracil administered as injectable chemotherapy, with each HCPCS unit representing 10 mg of drug.
CMS doesn’t publish an office rate for J9191 in Maine.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What J9191 covers
J9191 identifies injectable fluorouracil supplied as Avyxa, an antimetabolite used in cancer treatment. Oncology clinicians in practices and hospital outpatient infusion departments administer it intravenously by injection or infusion as part of a prescribed chemotherapy regimen. The code is product-specific: choose it when the administered product is Avyxa rather than another fluorouracil product represented by a neighboring entry.
CMS assigns status E, excluding J9191 from the physician fee schedule. When Medicare covers the drug, payment is under another method; HCPCS identifies it as a Part B drug generally priced using CMS quarterly ASP drug pricing files. Coverage is left to the Medicare contractor's judgment. One unit represents 10 mg, so divide the documented administered dose in milligrams by 10 to calculate units.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where J9191 pays more and less in Maine
| Payment locality | Office | Facility |
|---|---|---|
| Rest of Maine | Unavailable | Unavailable |
| Southern Maine, ME | Unavailable | Unavailable |
How the J9191 rate is calculated
Each of J9191’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · J9191
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for J9191
J9191 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · J9191
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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J9191 isn’t priced in this setting.
J9191 compared with similar codes
Compare codes · National
J9191 vs J9190 vs J9192: Medicare rates
How to choose
- J9190Fluorouracil injection500 mg per unit
- J9190 is another fluorouracil injection entry. Select the code that corresponds to the product administered.
- J9192Fluorouracil injectionPer 10 mg
- J9192 is a separate 10-mg fluorouracil entry without Avyxa in its descriptor. J9191 identifies the Avyxa product; select the entry matching the product administered.
J9191 billing questions
When should J9191 be used instead of J9190 or J9192?
Use J9191 for the Avyxa fluorouracil product. Choose another fluorouracil entry when the administered product corresponds to that code instead.
How many units should be reported?
One unit represents 10 mg. Divide the documented administered dose in milligrams by 10 to calculate units.
Does J9191 include chemotherapy administration?
J9191 identifies the drug, not the administration service. Report the applicable chemotherapy administration service separately when it is performed.
How does Medicare treat payment for J9191?
CMS assigns status E, excluding J9191 from the physician fee schedule. When covered, it is a Part B drug generally priced through CMS quarterly ASP drug pricing files, and coverage is left to the Medicare contractor's judgment.
What should the record support for this code?
Document the Avyxa product administered and the total fluorouracil dose in milligrams so the reported 10-mg units can be verified.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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