J9030 — Bcg live intravesical instillation, 1 mg
HCPCS/CPT
Prior Authorization
No Prior Auth Required
Code is covered without prior authorization (high confidence)
Medicare Pricing
Work RVU
0.00
Facility
N/A
Non-Facility
N/A
Documentation Required
- Medical record must document the actual number of milligrams of BCG instilled per treatment to support the number of J9030 units billed.
- Record the clinical indication (e.g., bladder cancer) and any justification for administering less than the FDA label dose (shortage-related) in the patient record.
Key Coverage Criteria
- Use HCPCS code J9030 (BCG live intravesical instillation, 1 mg) to report intravesical BCG treatments effective 2019-07-01.
- When actual instilled dose is less than the FDA label dose (81 mg / 1 vial) because of BCG shortage, report the actual reduced dose using J9030 with units equal to milligrams instilled.
1 Active Policy
A56754 — Billing and Coding: Intravesical Instillation of Bacillus Calmette-Guérin (BCG)
Have a follow-up question?
Ask Verity about documentation requirements, denial risks, or coverage in your state.