## **What is HCPCS code J9144?**
HCPCS code J9144 denotes the administration or injection of Darzalex Faspro® or Daratumumab combined with hyaluronidase fihj. Administered subcutaneously, this formulation is a monoclonal antibody used to treat adult patients with multiple myeloma and is also approved for certain types of light chain (AL) amyloidosis.
The code's descriptor is: "Injection, daratumumab, 10 mg and hyaluronidase-fihj" and said code is categorized under chemotherapy drugs by CMS. This means that each unit of J9144 billed represents 10 mg of the drug.
## **Documentation requirements**
Thorough and accurate documentation is essential for coverage and reimbursement. The medical record must clearly support the medical necessity of the treatment. Key documentation components include:
- **Diagnosis**: A definitive diagnosis of multiple myeloma or systemic light chain amyloidosis, supported by specific ICD-10 codes.
- **Provider order**: A signed and dated order from a hematologist or oncologist detailing the drug, dose, and frequency.
- **Patient history**: Documentation of the patient's medical history, including previous treatments, and a rationale for why Darzalex Faspro is the appropriate therapy at this time. This is particularly important for relapsed or refractory disease cases or individuals who are ineligible for an autologous stem cell transplant.
- **Administration records**: A detailed record of the drug's administration, including the date, time, route (subcutaneous), dose administered in milligrams, and the name/credentials of the person who administered it. The number of units billed (based on the 10 mg per unit ratio) must be clearly reconciled with the dose given.
- **Informed consent**: Documentation that the patient has been informed of the risks, adverse reactions, and benefits of the treatment and has provided consent.
Please note that coverage criteria may vary by payer; some may require prior authorization or documentation of maintenance of response.
## **Billing requirements**
Correct billing is vital to avoid claim denials. Key guidelines include:
- **HCPCS and units**: Bill J9144 with the correct number of units, where 1 unit = 10 mg.
- **Administration code**: Because J9144 is an injected drug, it must be billed alongside a CPT code for the administration service. For a subcutaneous injection, the most common code is 96401 (Chemotherapy administration, subcutaneous or intramuscular; non-hormonal antineoplastic).
- **NDC number**: Payers often require the National Drug Code (NDC) of the specific Darzalex Faspro product used. The NDC is typically an 11-digit number that identifies the product, its strength, and the manufacturer.
- **Modifiers**: JW Modifier for drug waste or JZ modifier if no waste occurs.
- **Payer-specific policies**: Coverage and billing rules for Darzalex Faspro can vary by payer (Medicare, Medicaid, commercial plans). Providers should always check the specific payer's medical policies or clinical criteria, as they may have unique requirements for prior authorization, length of therapy, and supported diagnoses.
## **Other relevant codes**
- **J9145**: Injection, daratumumab (without hyaluronidase), 10 mg.
- **J9047**: Injection, carfilzomib, 1 mg
- **J9263**: Injection, oxaliplatin, 0.5 mg
- **J9000**: Injection, doxorubicin hydrochloride, 10 mg
Frequently asked questions
