Question 1

What is HCPCS code J9394?

Accepted Answer

HCPCS code J9394 is "Inj, fulvestrant (fresenius)". Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg

Question 2

What category is J9394 in?

Accepted Answer

J9394 belongs to HCPCS Category J (Drugs Administered Other Than Oral).

Question 3

When should I use HCPCS code J9394?

Accepted Answer

Use J9394 when billing for inj, fulvestrant (fresenius). HCPCS Level II codes like this are used for items and services not covered by CPT codes, including medical supplies, equipment, drugs administered in clinical settings, and certain healthcare services.

Question 4

Is J9394 covered by Medicare?

Accepted Answer

Coverage for J9394 (Inj, fulvestrant (fresenius)) depends on medical necessity and specific Medicare guidelines. Check the applicable Local Coverage Determination (LCD) or National Coverage Determination (NCD) for detailed coverage criteria. Private insurers may have different coverage policies.

Question 5

What documentation is required for J9394?

Accepted Answer

Documentation for J9394 should include: the medical necessity for the item or service, supporting diagnosis codes (ICD-10), prescription or order from the treating physician, and proof that the item meets quality standards. Some items may require additional documentation like a Certificate of Medical Necessity (CMN).