HCPCS code J9205: Liposomal irinotecan, per 1 mg2026 Medicare rate & RVUs in Guam
Reports liposomal irinotecan administered by intravenous infusion, including in combination regimens for pancreatic adenocarcinoma, with units based on each milligram administered.
CMS doesn’t publish an office rate for J9205 in Guam.
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
On this page 9 sections
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.
J9205 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
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
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
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.
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
Fee sheets · Coming soon
Put J9205 and the rest of your codes on one sheet
Your codes at your locality, with payer contracts beside Medicare.
Join the waitlist