HCPCS Code J9202: Goserelin Acetate Implant, Per 3.6 mg

Learn about the HCPCS code J9202 for "goserelin acetate implant, per 3.6 mg" through this short guide.

## **What is the HCPCS code J9202 for?** The HCPCS code J9202 is meant to designate the injection of a goserelin acetate implant, specifically every 3.6 mg dose. Goserelin acetate implants function by releasing goserelin acetate (a gonadotropin-releasing hormone/GnRH agonist) over time after being injected into the body. What it does is downregulate pituitary gonadotropin release. By doing so, this suppresses luteinizing hormones (LH) and follicle-stimulating hormones (FSH), which, in turn, reduces sex hormone production. By regulating hormone production, it can help slow down the progression and growth of hormone-sensitive cancers, such as prostate cancer, breast cancer, epithelial ovarian cancer, primary peritoneal cancer, fallopian tube cancer, and more. This injection is inserted into the subcutaneous tissue. It's also used alongside endocrine therapy.

## **Documentation requirements for J9202** As with any HCPCS code, you need to have sufficient documentation related to the code you plan on filing a claim for. Here are examples of what you'll need for J9202: - The full name of the patient - The name and address of the facility where the injection was administered - The full name and credentials of the healthcare professionals who handled the patient - The date and time of the administration of the implant - The administration schedule - Patient records showing they have been diagnosed with any cancers this medication treats, or gynecologic disorders (endometriosis, dysfunctional uterine bleeding) - Blood test results that show hormone levels - Imaging test results showing locations and sizes of tumors (if any) - The exact dosage, including the route

## **Billing requirements for J9202** Besides the documentation requirements above, please make sure to have the following: ### **Related ICD codes** Here are some examples of ICD codes that you must have. Make sure the one you'll use is related to your patients condition. - N80.391 - Superficial endometriosis of the pelvic peritoneum, other specified sites - C50.012 - Malignant neoplasm of nipple and areola, left female breast - N80.C11 - Endometriosis of the anterior abdominal wall, subcutaneous tissue - C50.119 - Malignant neoplasm of central portion of unspecified female breast - C50.129 - Malignant neoplasm of central portion of unspecified male breast - C50.911 - Malignant neoplasm of unspecified site of right female breast ### **Other requirements** Besides the ICD codes, make sure to have or take note of the following: - 1 unit = 3.6 mg implant. Ensure the claim reflects accurate units matching the dosage and schedule - Pair J9202 with the appropriate administration code, such as CPT 96402 (chemotherapy or hormone therapy injection, subcutaneous or intramuscular, requiring moderate sedation or complex evaluation) when required - Be mindful of payer authorization requirements, which often require documentation of indication, prior therapy, and response. For example, for prostate cancer, certain payers (like Aetna) may consider Zoladex only if alternatives like Eligard are contraindicated or ineffective

## **Other similar codes** - **J1950** - Injection, leuprolide acetate (for depot suspension), per 3.75 mg - **J9218** - Leuprolide acetate, per 1 mg - **J3316** - Injection, triptorelin, extended-release, 3.75 mg - **J9226** - Histrelin implant (supprelin la), 50 mg - **J3315** - Injection, triptorelin pamoate, 3.75 mg