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HCPCS code J9205: Liposomal irinotecan, per 1 mg2026 Medicare rate & RVUs

Reports liposomal irinotecan administered by intravenous infusion, including in combination regimens for pancreatic adenocarcinoma, with units based on each milligram administered.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J9205

Liposomal irinotecan, per 1 mg

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for J9205 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What J9205 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What J9205 covers

J9205 identifies the liposomal formulation of irinotecan, an antineoplastic drug administered by intravenous infusion. Oncology clinicians administer it in intravenous chemotherapy regimens, and oncology practices report the drug dose. For metastatic pancreatic adenocarcinoma, it is used with fluorouracil and leucovorin after disease progression following gemcitabine-based therapy; a first-line regimen also combines it with oxaliplatin, fluorouracil, and leucovorin. The liposomal formulation is distinct from conventional irinotecan, so code the product actually administered.

Each HCPCS unit represents 1 mg of liposomal irinotecan; report units based on the milligrams administered. CMS assigns physician fee schedule status E, meaning the drug is excluded from the physician fee schedule by regulation. When Medicare covers it, payment is under another method; the HCPCS pricing method identifies it as a Part B drug generally paid from CMS's quarterly ASP drug pricing files. CMS's coverage code calls for special Medicare coverage instructions.

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 J9205 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J9205 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

J9205 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
J9205 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the J9205 rate is calculated

Each of J9205’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 · J9205

RVUs × geographic indexes × conversion factor

Office or facility?

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 J9205

J9205 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 · J9205

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

J9205 isn’t priced in this setting.

J9205 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • J9205

    Liposomal irinotecan, per 1 mg0 wRVU

    Not priced

  • J9206

    Irinotecan injection, per 20 mg0 wRVU

    Not priced

  • J9190

    Fluorouracil injection, 500 mg per unit0 wRVU

    Not priced

  • J9263

    Oxaliplatin, per 0.5 mg0 wRVU

    Not priced

How to choose

J9206Irinotecan injectionPer 20 mg
J9205 identifies liposomal irinotecan. J9206 identifies conventional irinotecan, a different formulation.
J9190Fluorouracil injection500 mg per unit
J9190 represents fluorouracil, which may accompany liposomal irinotecan in a regimen; it is not the irinotecan drug.
J9263OxaliplatinPer 0.5 mg
J9263 represents oxaliplatin, which may be part of a combination regimen. J9205 is the code for liposomal irinotecan.

Codes related to J9205

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to J9205
CodeHow it relatesNational office range
Used instead
J9206Irinotecan injection, per 20 mgRepresents conventional irinotecan rather than the liposomal product.No office rate
Often billed with
J9190Fluorouracil injection, 500 mg per unitFluorouracil is used with liposomal irinotecan in pancreatic cancer combination regimens.No office rate
J0640Leucovorin injection, per 50 mgLeucovorin is used with fluorouracil in combination regimens involving liposomal irinotecan.No office rate
J9263Oxaliplatin, per 0.5 mgOxaliplatin is included with liposomal irinotecan in a pancreatic cancer combination regimen.No office rate

J9205 billing questions

When should J9205 be used instead of J9206?

Use J9205 for the liposomal irinotecan product. J9206 represents conventional irinotecan; the products have different formulations.

How many units should be reported?

One unit represents 1 mg of liposomal irinotecan. Calculate units from the milligrams administered.

What administration route does J9205 describe?

The drug is administered by intravenous infusion.

What documentation supports J9205?

Document the liposomal product administered, the dose in milligrams, and the treatment record supporting the administered amount.

How does Medicare treat J9205?

CMS assigns status E, excluding it from the physician fee schedule by regulation. When covered, it is a Part B drug generally paid using CMS quarterly ASP drug pricing files, and special Medicare coverage instructions apply.

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

Open CMS sourceHow we calculate rates

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