J9201 — Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
J9201 is a HCPCS Level II code for injection, gemcitabine hydrochloride, not otherwise specified, 200 mg. It belongs to the Drugs Administered Other Than Oral Method section. Whether Medicare pays it depends on the coverage rule below.
Medicare coverage: Special coverage instructions apply
There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
From the coverage field of the CMS Alpha-Numeric HCPCS File, release 2026Q3-Jul. This states Medicare’s position on the code, not on your particular claim.
Physician fee schedule statusE
Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).
Global period: XXX
Want the dollar amount for your locality? The fee calculator applies your GPCI and the current conversion factor.
Medically Unlikely Edits — units per day
The most units of J9201 Medicare will pay on one date of service. Bill more on a single line and it is denied. The limit is not the same in every setting, so the row that matters is the one matching the claim you are building.
- practitioner
- 20 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- outpatient
- 20 units MAI 3 — Date of Service Edit: Clinical · Prescribing Information
- DME supplier
- 0 — never payable MAI 3 — Date of Service Edit: Clinical · CMS Policy
The adjudication indicator decides whether exceeding the limit is worth appealing at all: MAI 1 is a line edit you can support with documentation, MAI 3 is a date-of-service edit that is also appealable, and MAI 2 is absolute — no documentation overrides it. CMS MUE 2026Q3.
The CMS record for J9201
- Long descriptor
- Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
- Short descriptor
- In gemcitabine hcl nos 200mg
- Added
- January 1, 1998
- BETOS
- O1D
- Pricing indicator
- 51 — Other
The official wording. This is what the code means.
CMS's 28-character form, which is what shows up on a remittance advice.
When CMS introduced the code.
Berenson-Eggers Type of Service — CMS's own analytic grouping.
Drugs.
Codes adjacent to J9201
HCPCS has no hierarchy — related items simply sit next to each other in the numbering. If J9201 is not quite right, the correct code is very often within a few positions of it.
- J9183Gemcitabine intravesical system, 225 mg
- J9184Injection, gemcitabine hydrochloride (avyxa), 200 mg
- J9185Injection, fludarabine phosphate, 50 mg
- J9190Injection, fluorouracil, 500 mg
- J9196Injection, gemcitabine hydrochloride (accord), not therapeutically equivalent to j9201, 200 mg
- J9198Injection, gemcitabine hydrochloride, (infugem), 100 mg
- J9199Injection, gemcitabine hydrochloride (infugem), 200 mgterminated
- J9200Injection, floxuridine, 500 mg
- J9202Goserelin acetate implant, per 3.6 mg
- J9203Injection, gemtuzumab ozogamicin, 0.1 mg
- J9204Injection, mogamulizumab-kpkc, 1 mg
- J9205Injection, irinotecan liposome, 1 mg
- J9206Injection, irinotecan, 20 mg
- J9207Injection, ixabepilone, 1 mg
- J9208Injection, ifosfamide, 1 gram
- J9209Injection, mesna, 200 mg
Questions about J9201
What is HCPCS code J9201?
J9201 is a HCPCS Level II code for injection, gemcitabine hydrochloride, not otherwise specified, 200 mg. It sits in the Drugs Administered Other Than Oral Method section.
Does Medicare cover J9201?
The CMS HCPCS file marks J9201 as "Special coverage instructions apply". There are published conditions attached to this code. Check the applicable coverage policy before billing it: the code being valid is not the same as the service being covered.
How is J9201 paid under the physician fee schedule?
J9201 carries PFS status code E. Excluded from the physician fee schedule by regulation. Payment, where it exists, comes from another fee schedule (drugs via ASP, supplies via DMEPOS, and so on).