HCPCS
J9060
1 unit = 10 mg
About cisplatin (J9060) Generic since 1990s
Cisplatin is the prototypical platinum-coordination cytotoxic, FDA-approved in 1978 under the originator Bristol-Myers Squibb brand Platinol (NDA 18-057). The Platinol brand has been discontinued and the U.S. market is served entirely by generic manufacturers including Hospira/Pfizer, Teva, Accord Healthcare, WG Critical Care, and Fresenius Kabi. Cisplatin remains the cornerstone of multiple curative-intent regimens: BEP / EP for testicular germ cell tumor (the modern era's most curable solid tumor), cisplatin + concurrent radiation for locally advanced head & neck squamous cell carcinoma and cervical cancer, cisplatin + etoposide (EP) for limited-stage small-cell lung cancer with thoracic radiation, cisplatin + pemetrexed for non-squamous NSCLC and pleural mesothelioma, and cisplatin + gemcitabine (GC) or MVAC for muscle-invasive bladder cancer.
Despite being cheap and generic, cisplatin remains operationally complex to administer: it requires 1–2 L of saline pre- and post-hydration for nephroprotection, magnesium repletion in the hydration bag, full HEC triple-anti-emetic premedication (NK1 + 5-HT3 + dexamethasone, often with olanzapine), and audiogram monitoring at cumulative doses > 200 mg/m². Total chair time per encounter is typically 6–8 hours including hydration. These operational demands strongly favor hospital outpatient (HOPD) or established oncology office infusion centers over ASC or home administration.
For billing purposes, cisplatin is HCPCS J9060 with 1 unit = 10 mg. This is a critical unit-basis distinction: oxaliplatin (J9263) is per 0.5 mg, carboplatin (J9045) is per 50 mg. Per-mg drug cost is among the lowest in cytotoxic chemotherapy, but the administration codes, hydration, anti-emetic premedications, and complications drive the encounter economics.
Phase 1
Identify what you're billing
Confirm the regimen, schedule (q3w vs weekly vs fractionated), BSA, and hydration plan.
Combination regimens that include cisplatin NCCN verified May 2026
Cisplatin is almost never monotherapy. Each regimen has its own schedule, hydration plan, and combination admin coding.
| Regimen | Components | Cisplatin dose | Cycle | Primary indication |
|---|---|---|---|---|
| BEP | Bleomycin + etoposide + cisplatin | 20 mg/m²/day × 5 | 21 days × 3–4 cycles | Testicular germ cell tumor (curative) |
| EP | Etoposide + cisplatin | 20 mg/m²/day × 5 (testicular) OR 75–80 mg/m² Day 1 (SCLC) | 21 days | Good-risk testicular GCT; limited-stage SCLC + thoracic RT |
| Cisplatin + RT (q3w high-dose) | Cisplatin + concurrent radiation | 100 mg/m² Day 1 | 21 days × 3 cycles during RT | Locally advanced HNSCC; cervical cancer (concurrent chemoradiation) |
| Cisplatin + RT (weekly low-dose) | Cisplatin + concurrent radiation | 40 mg/m² weekly | 7 weeks during RT | HNSCC, cervical cancer (alternative for patients who can't tolerate q3w) |
| Cisplatin + 5-FU | Cisplatin + infusional 5-FU | 100 mg/m² Day 1 | 21–28 days | Recurrent/metastatic HNSCC; gastric (legacy) |
| Cisplatin + pemetrexed | Cisplatin + pemetrexed (J9305) | 75 mg/m² Day 1 | 21 days | Non-squamous NSCLC (1L); pleural mesothelioma |
| Cisplatin + gemcitabine (GC) | Cisplatin + gemcitabine (J9201) | 70 mg/m² Day 1 or 2 | 21–28 days | Muscle-invasive bladder cancer (neoadjuvant + metastatic) |
| MVAC / dd-MVAC | Methotrexate + vinblastine + doxorubicin + cisplatin | 70 mg/m² Day 2 | 28 days (dd-MVAC: 14 days) | Muscle-invasive / metastatic bladder cancer |
| TIP / VIP salvage | Paclitaxel/etoposide + ifosfamide + cisplatin | 20 mg/m²/day × 5 | 21 days | Relapsed/refractory germ cell tumor |
| Cisplatin + Keytruda | Cisplatin + 5-FU + pembrolizumab (J9271) | 100 mg/m² Day 1 (HNSCC) or 80 mg/m² (gastric) | 21 days | 1L recurrent/metastatic HNSCC; gastric (KEYNOTE-048, KEYNOTE-590) |
The schedule type determines the encounter. Single-day q3w high-dose cisplatin
(75–100 mg/m²) is the most common adult schedule. The 5-day fractionated 20 mg/m²/day schedule
(BEP/EP/TIP/VIP) means the patient comes in for 5 consecutive infusion encounters per cycle — each
with its own hydration, infusion, and admin coding. Weekly 40 mg/m² during HNSCC radiation generates
7 separate infusion encounters per course. Coding by encounter type matters more than coding by drug.
Combination admin coding: cisplatin is typically the initial drug billed at
96413. Subsequent agents (etoposide, 5-FU, pemetrexed, gemcitabine) bill
96417 (each additional sequential infusion). The 5-FU infusional component in HNSCC cisplatin
+ 5-FU regimens bills 96416 for take-home pump initiation. Hydration codes
96360 + 96361 are also separately billable. Verify your charge capture has all
codes for the full encounter.
Dosing & unit math FDA label verified May 2026
From the FDA prescribing information (generic cisplatin SPLs).
BSA-based dosing — convert mg to J9060 units
Cisplatin is dosed in milligrams per square meter of body surface area (mg/m²). Convert administered milligrams to J9060 units by dividing mg by 10 (round up to nearest whole unit).
- HNSCC, cervical, NSCLC (q3w high-dose with radiation): 100 mg/m² Day 1
- NSCLC non-squamous + pemetrexed: 75 mg/m² Day 1
- Mesothelioma + pemetrexed: 75 mg/m² Day 1
- Bladder (GC): 70 mg/m² Day 1 or 2
- Bladder (MVAC): 70 mg/m² Day 2
- Testicular germ cell (BEP/EP/TIP): 20 mg/m²/day × 5 days
- SCLC (EP): 75–80 mg/m² Day 1 (or 25 mg/m²/day × 3)
- HNSCC concurrent radiation (weekly): 40 mg/m² weekly × 7
BSA-to-units quick reference
| BSA (m²) | 75 mg/m² (mg / units) | 100 mg/m² (mg / units) | 20 mg/m² daily (mg / units) |
|---|---|---|---|
| 1.5 | 113 mg / 12 units | 150 mg / 15 units | 30 mg / 3 units |
| 1.7 | 128 mg / 13 units | 170 mg / 17 units | 34 mg / 4 units |
| 1.85 | 139 mg / 14 units | 185 mg / 19 units | 37 mg / 4 units |
| 2.0 | 150 mg / 15 units | 200 mg / 20 units | 40 mg / 4 units |
| 2.2 | 165 mg / 17 units | 220 mg / 22 units | 44 mg / 5 units |
Worked example — 100 mg/m² cisplatin + RT cycle for a 1.85 m² HNSCC patient
# Step 1 — calculate dose
BSA: 1.85 m² × 100 mg/m² = 185 mg
# Step 2 — vial selection (multi-dose vials)
Draw from one 200 mg / 200 mL MDV (or 2 × 100 mg MDVs)
Multi-dose vial: residual returns to inventory for next patient
# Step 3 — convert mg to J9060 units (mg / 10, round up)
Administered units: 185 / 10 = 18.5 → 19 units
Do NOT append JZ or JW for multi-dose NDC.
# Step 4 — admin coding for ~6 hr encounter
Pre-hydration (1 L NS over 2 hr):
Cisplatin (1–2 hr):
Post-hydration (1 L NS over 2–4 hr):
Anti-emetic premeds:
# Drug reimbursement (Q2 2026 ASP+6%)
19 units × ~$2.166 = ~$41.15
# Admin + hydration + anti-emetic codes generate substantially more revenue than the drug.
BSA: 1.85 m² × 100 mg/m² = 185 mg
# Step 2 — vial selection (multi-dose vials)
Draw from one 200 mg / 200 mL MDV (or 2 × 100 mg MDVs)
Multi-dose vial: residual returns to inventory for next patient
# Step 3 — convert mg to J9060 units (mg / 10, round up)
Administered units: 185 / 10 = 18.5 → 19 units
Do NOT append JZ or JW for multi-dose NDC.
# Step 4 — admin coding for ~6 hr encounter
Pre-hydration (1 L NS over 2 hr):
96360 ×1 + 96361 ×1Cisplatin (1–2 hr):
96413 ×1 (+ 96415 ×1 if > 1 hr)Post-hydration (1 L NS over 2–4 hr):
96361 × 2–3Anti-emetic premeds:
96367 per agent# Drug reimbursement (Q2 2026 ASP+6%)
19 units × ~$2.166 = ~$41.15
# Admin + hydration + anti-emetic codes generate substantially more revenue than the drug.
Pediatric germ cell / solid tumor dosing
- Pediatric BEP (POG/COG): cisplatin 20 mg/m²/day IV days 1–5 of each 21-day cycle
- Hepatoblastoma C5V regimen: cisplatin 100 mg/m² Day 1
- Neuroblastoma high-risk induction: cisplatin 50 mg/m²/day IV days 1–2 or fractionated
- Audiogram before each cycle (lower threshold than adult monitoring); consider Pedmark (sodium thiosulfate, J9248) for ototoxicity prevention in pediatric patients with localized non-metastatic solid tumors (FDA-approved 2022)
Diluent: 0.9% NaCl (saline) — opposite of oxaliplatin, which requires D5W. Cisplatin is
stable in chloride-containing solutions; the chloride actually stabilizes the platinum-aqua complex. Do
not substitute D5W for cisplatin and do not substitute NS for oxaliplatin — verify pharmacy compounding
order matches the drug.
Hydration protocol — the operational center of the cisplatin encounter Verified May 2026
Aggressive saline diuresis is the standard of care for cisplatin nephroprotection. This drives chair time, site of care, and the full set of admin codes.
| Phase | Volume / Fluid | Duration | Billing code |
|---|---|---|---|
| Pre-hydration | 1–2 L 0.9% NaCl (+ 8–20 mEq MgSO₄ ± KCl) | 2–4 hr | 96360 initial + 96361 each addl hr |
| Anti-emetic premedication | NK1 RA (aprepitant 125 mg PO or fosaprepitant 150 mg IV) + 5-HT3 RA (palonosetron 0.25 mg IV) + dexamethasone 12 mg IV ± olanzapine 5–10 mg PO | 30 min | 96367 each addl sequential non-chemo drug |
| Cisplatin infusion | Dose in 250–500 mL 0.9% NaCl | 1–2 hr | 96413 hr 1 + 96415 ×1 if > 1 hr |
| Post-hydration | 1–2 L 0.9% NaCl (target urine output ≥ 100 mL/hr × 6–8 hr) | 2–6 hr | 96361 each addl hr |
| Optional: mannitol diuresis | 12.5–25 g IV during cisplatin if urine output inadequate | during infusion | included in admin codes |
Total encounter time: 6–8 hours typically. A 100 mg/m² cisplatin + radiation
encounter is rarely under 5 hours of chair time and may extend to 8+ hours if post-hydration is fully
protocol-compliant. This is the primary operational reason cisplatin is favored in HOPD and established
oncology office infusion centers rather than ASC settings — chair turnover is slow.
Magnesium replacement is standard. Cisplatin causes renal magnesium wasting; baseline Mg
should be measured before each cycle and 8–20 mEq MgSO₄ added to the hydration bag. Hypomagnesemia
worsens nephrotoxicity, so documentation of baseline Mg and intra-infusion Mg replacement supports payer
audit defense if AKI develops.
"Short hydration" protocols exist for selected centers and lower-dose regimens
(e.g., 75 mg/m²): 1 L pre + 1 L post over a total ~4 hours. These reduce chair time but require strict
eligibility (good baseline renal function, adequate baseline magnesium, no other nephrotoxin exposure). Most
institutions still default to conventional hydration for high-dose cisplatin (100 mg/m²) and curative-intent
regimens (BEP, cisplatin + RT).
NDC reference (representative generics) FDA NDC Directory verified May 2026
Multiple manufacturers; submit the actual NDC of the vial used. Most U.S. supply is multi-dose vials — verify presentation before applying JW/JZ.
| Manufacturer | NDC (10/11-digit) | Vial size | Container type |
|---|---|---|---|
| Hospira / Pfizer (Teva-source) | 0703-5747-11 / 00703-5747-11 |
50 mg / 50 mL | Multi-dose vial (1 mg/mL) |
| Hospira / Pfizer (Teva-source) | 0703-5748-11 / 00703-5748-11 |
100 mg / 100 mL | Multi-dose vial (1 mg/mL) |
| Accord Healthcare | 16729-288-11 / 16729-0288-11 |
50 mg / 50 mL | Multi-dose vial (1 mg/mL) |
| Accord Healthcare | 16729-288-38 / 16729-0288-38 |
100 mg / 100 mL | Multi-dose vial (1 mg/mL) |
| WG Critical Care | 44567-509-12 / 44567-0509-12 |
100 mg / 100 mL | Multi-dose vial (1 mg/mL) |
| Fresenius Kabi | 63323-103-51 / 63323-0103-51 |
50 mg / 50 mL | Multi-dose vial (1 mg/mL) |
| Fresenius Kabi | 63323-104-65 / 63323-0104-65 |
100 mg / 100 mL | Multi-dose vial (1 mg/mL) |
| BMS Platinol (originator) | n/a | n/a | Discontinued — originator brand no longer marketed |
Multi-dose vial → modifier behavior differs from oxaliplatin/carboplatin. Cisplatin's
standard 50/100/200 mg-per-mL multi-dose vials with bacteriostatic preservative are not subject to
the CMS JW/JZ single-dose container policy. Do not auto-append JZ or JW to J9060 lines without
confirming the actual NDC's container type. Submit the actual NDC from the lot dispensed; brief lyophilized
powder presentations may exist with different rules, but solution MDVs dominate U.S. supply.
Drug shortage history. Cisplatin has appeared on the FDA drug shortage list intermittently
(notably 2023–2024). Verify supply availability with your wholesaler and consider regimen substitution
plans (carboplatin where carboplatin is non-inferior; not for BEP testicular GCT where carboplatin is
inferior). Document any shortage-driven substitution in payer notes.
Phase 2
Code the claim
Cisplatin admin = chemo codes + hydration codes + anti-emetic codes. JW/JZ generally N/A.
Administration codes CPT verified May 2026
Cisplatin is true cytotoxic chemotherapy. Add hydration codes for the pre/post saline and anti-emetic codes for premeds.
| Code | Description | When to use |
|---|---|---|
96413 |
Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug | Hour 1 of cisplatin infusion (always primary). One unit per encounter as the initial chemo drug. |
96415 |
Chemotherapy administration, IV infusion; each additional hour | Hour 2 of cisplatin if infusion exceeds 1 hr. Typical 1–2 hr infusion = × 1 unit when ordered over 2 hr. |
96417 |
Chemotherapy administration, IV infusion technique; each additional sequential infusion (different substance/drug) | For each subsequent chemo agent in the cycle (etoposide, 5-FU, pemetrexed, gemcitabine) |
96416 |
Initiation of prolonged chemotherapy infusion (more than 8 hours) requiring portable or implantable pump | For continuous 5-FU infusion via take-home pump in cisplatin + 5-FU HNSCC regimens |
96360 |
Intravenous infusion, hydration; initial 31 minutes to 1 hour | First hour of pre-hydration saline. Required for cisplatin nephroprotection protocol. |
96361 |
Hydration; each additional hour | Each additional hour of pre- and post-hydration saline beyond the first hour |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | For anti-emetic IV infusions if billed separately (e.g., fosaprepitant 150 mg IV); typically 96367 sequential is used instead |
96367 |
Therapeutic IV infusion; each additional sequential infusion of a new drug/substance | Each anti-emetic IV premed (5-HT3 RA, dexamethasone, fosaprepitant) sequenced before or after cisplatin |
96375 |
Therapeutic IV push; each additional sequential push of a new drug/substance | For IV push anti-emetics (e.g., ondansetron 8 mg IV push) sequenced with infusions |
Hydration codes are the cisplatin-specific add-on. Unlike oxaliplatin or carboplatin
encounters, cisplatin pre- and post-hydration is the standard of care and is separately billable as
96360 + 96361 for the non-chemo hours of saline running. Document the start
and end times of each fluid in the medical record; payers occasionally audit hydration claim hours against
the documented chair time.
Do NOT bill therapeutic IV infusion (96365) for cisplatin itself. Cisplatin is true
cytotoxic chemotherapy — chemo admin codes (96413/96415/96417) apply. Save 96365/96366 for non-chemo
therapeutic infusions running concurrently or sequentially.
Modifiers — JZ/JW often DO NOT apply to cisplatin CMS verified May 2026
Why cisplatin modifier behavior is different from oxaliplatin or biologics
CMS's July 2023 JZ/JW policy applies specifically to single-dose containers. The U.S. cisplatin generic supply is dominated by preserved multi-dose vials (50 mg/50 mL, 100 mg/100 mL) where residual drug returns to inventory for the next patient. Multi-dose vials are excluded from the JZ/JW requirement. Do not auto-append JZ or JW to J9060 claims for multi-dose NDCs — auditors flag this as inappropriate modifier use.
| Modifier | Use | Cisplatin-specific guidance |
|---|---|---|
JZ |
Reports zero discarded drug from a single-dose container | Do NOT append for standard multi-dose vial NDCs. Append ONLY if the dispensed NDC is verified single-dose. |
JW |
Reports the discarded portion of a single-dose vial when waste exists | Do NOT append for multi-dose NDCs. Multi-dose residual is not "waste" — it goes back to inventory. |
25 (E/M) |
Significant separately identifiable E/M same day as infusion | Use on the E/M line, not on J9060. Pre-infusion clinical assessment is bundled into the encounter. |
JG / TB |
340B-acquired drug modifiers per MAC policy | Required if facility participates in 340B and cisplatin is 340B-purchased. Verify per MAC. |
59 (distinct procedural service) |
Distinct service same day | Sometimes needed to break NCCI edits between hydration and chemo codes; verify MAC policy. |
Common error: billing JW or JZ on a multi-dose NDC. This is inappropriate modifier use
and is flagged in CMS audits. The correct path: verify the lot's NDC, check container type (MDV vs SDV),
and append JZ/JW only for verified single-dose presentations.
If your facility uses single-dose cisplatin NDCs: apply the same JZ-on-administered /
JW-on-waste convention as oxaliplatin (see oxaliplatin modifier
guidance). But verify the actual container type for every lot — single-dose cisplatin is the
exception, not the rule.
ICD-10-CM by indication FY2026 verified May 2026
Cisplatin is on-label across multiple solid tumors. Use the most specific code supported by encounter documentation, including histology and laterality where relevant.
| Indication | ICD-10 family | Notes |
|---|---|---|
| Head & neck squamous cell carcinoma | C00–C14 (lip, oral, pharynx) | Locally advanced concurrent chemoradiation 100 mg/m² q3w × 3 |
| Larynx | C32.x | HNSCC with cisplatin + RT (organ preservation) |
| NSCLC (non-squamous) | C34.x | Cisplatin + pemetrexed 1L; cisplatin + etoposide |
| NSCLC (squamous) | C34.x | Cisplatin + gemcitabine or paclitaxel; not pemetrexed |
| Small cell lung cancer (limited / extensive) | C34.x | EP (etoposide + cisplatin) + thoracic RT |
| Esophageal cancer | C15.3–C15.9 | Cisplatin + 5-FU (CROSS regimen with RT); cisplatin + Keytruda KEYNOTE-590 |
| Gastric / GEJ cancer | C16.0–C16.9 | Cisplatin + 5-FU or capecitabine; cisplatin + Keytruda (HER2-negative) |
| Pleural mesothelioma | C45.0 | Cisplatin + pemetrexed (FDA-approved 1L) |
| Bladder (muscle-invasive / metastatic) | C67.x | Neoadjuvant GC or dd-MVAC; metastatic GC or MVAC |
| Cervical cancer | C53.x | Locally advanced concurrent chemoradiation; recurrent 1L cisplatin + paclitaxel + bevacizumab ± Keytruda |
| Ovarian (epithelial) | C56.x | Carboplatin is preferred 1L; cisplatin used in selected intraperitoneal protocols |
| Ovarian germ cell tumor | C56.x (+ C76 if mass) | BEP cisplatin 20 mg/m² × 5 days q3w |
| Testicular germ cell tumor | C62.0 (undescended), C62.10, C62.90 | BEP/EP curative; PEB pediatric protocols |
| Anal canal squamous | C21.x | Cisplatin + 5-FU + RT (alternative to 5-FU/MMC) |
| Pediatric neuroblastoma / hepatoblastoma | C74.x, C22.2 | Cisplatin in COG/COG-International protocols |
| Acute kidney injury (drug-induced) | N14.1 | For documenting nephrotoxicity if AKI develops post-cisplatin |
| Sensorineural hearing loss | H90.3, H90.41–H90.42 | For audiogram follow-up after cumulative dose > 200 mg/m² |
| Hypomagnesemia | E83.42 | For Mg replacement post-cisplatin |
| Drug-induced peripheral neuropathy | G62.0 | For neuropathy management visits |
| Personal hx of malignant neoplasm | Z85.x (various) | For surveillance after curative cisplatin therapy |
Histology matters for NSCLC PA. Cisplatin + pemetrexed is approved only for
non-squamous NSCLC; cisplatin + gemcitabine or paclitaxel applies to squamous. PA submissions
for cisplatin + pemetrexed in NSCLC require explicit non-squamous histology documentation (adenocarcinoma,
large cell, NOS-not-squamous).
Site of care & place of service Verified May 2026
Cisplatin is administered almost exclusively in hospital outpatient departments and established oncology office infusion centers because the encounter requires 6–8 hours of chair time (1–2 L pre-hydration + 1–2 hr infusion + 1–2 L post-hydration) plus resuscitation capability for rare hypersensitivity. ASC steering is uncommon; home administration is essentially never done.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Preferred for high-dose cisplatin regimens given hydration + monitoring complexity |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Acceptable for established cisplatin patients; some commercial UM disfavors after first 3 months |
| Physician oncology office | 11 | CMS-1500 / 837P | Acceptable for lower-dose schedules (40 mg/m² weekly, 75 mg/m²) when infusion center has full hydration and monitoring |
| Ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Less common — chair-time intensity makes turnover uneconomic for most AICs |
| Oncology ASC | 24 | CMS-1500 / 837P | Uncommon — ASC chair-time economics generally don't support 6–8 hr encounters |
| Patient home | 12 | n/a | Essentially never used — hydration volume, anti-emetic premeds, and monitoring require infusion-center setting |
Why HOPD preference holds for cisplatin. Even commercial UM that aggressively steers
biologics out of HOPD generally accepts in-office or HOPD cisplatin because (1) total chair time is 6–8 hr
per encounter; (2) hydration + Mg replacement requires nursing capacity; (3) anti-emetic premeds, monitoring
of urine output, and immediate-availability rescue for hypersensitivity are easier in HOPD; (4) cisplatin
drug cost is small relative to admin and supportive-care codes, so the cost arbitrage that drives biologic
site-of-care steering doesn't really apply.
Claim form field mapping Verified May 2026
CMS-1500 / 837P fields for a cisplatin + radiation encounter (HNSCC, 100 mg/m², 1.85 m² patient).
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering oncologist |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + actual lot NDC + ML + total volume drawn (e.g., 185 mL for 185 mg from MDV) |
| HCPCS J9060 (administered units) | 24D (drug line) | Units = mg / 10, rounded up (185 mg = 19 units). No JZ/JW for multi-dose NDC. |
| Drug units | 24G | e.g., 19 for 185 mg dose |
| CPT 96360 (hydration initial) | 24D admin line | First hour of pre-hydration saline |
| CPT 96361 (hydration addl hr) | 24D admin line | One unit per additional hr of hydration (pre + post) |
| CPT 96413 (chemo admin, hour 1) | 24D admin line | One unit, cisplatin as initial chemo drug |
| CPT 96415 (chemo admin, addl hr) | 24D admin line | One unit if infusion exceeds 1 hr |
| CPT 96367 (sequential non-chemo) | 24D admin line | One per anti-emetic IV premed (fosaprepitant, palonosetron, dex) |
| CPT 96417 (each addl sequential chemo) | 24D admin line | One per subsequent chemo agent (etoposide, 5-FU, pemetrexed) |
| ICD-10 | 21 | Indication-specific (see ICD-10 table) |
| PA number | 23 | Most commercial payers; Medicare LCDs cover FDA + NCCN |
Phase 3
Get paid
Generic cisplatin rarely the PA bottleneck. Combo agents (Keytruda, pembrolizumab, bevacizumab) drive PA friction.
Payer policy snapshot Reviewed May 2026
| Payer | PA (cisplatin alone)? | Concurrent PA on combo agents? | Notes |
|---|---|---|---|
| Medicare (MAC LCDs) | No (covered for FDA + NCCN-recommended uses) | n/a | NCD/LCD framework covers cisplatin per FDA label + NCCN guidelines (off-label use compendium-supported) |
| UnitedHealthcare | Yes (oncology medical drug policy) | Yes — PA on pembrolizumab, bevacizumab combos | Cisplatin itself rarely denied for on-label HNSCC/cervical/NSCLC/bladder/testicular; aggressive UM via Optum-managed program for HOPD biologics |
| Aetna | Yes (CPB + Medical Drug policy) | Yes | Histology + line of therapy documentation required for NSCLC and gastric pembrolizumab combos |
| BCBS plans | Generally no for cisplatin alone; varies by plan | Yes for combo biologics | Generally aligned with NCCN guidelines + FDA label |
Step therapy
Generally NOT required for cisplatin in FDA-labeled curative-intent indications (testicular GCT, HNSCC + RT, cervical + RT, bladder neoadjuvant). Some payers require documented contraindication to cisplatin before approving carboplatin substitution for indications where cisplatin is the standard (e.g., adjuvant cervical, BEP testicular). Verify per-payer.
The PA fight is rarely about cisplatin itself. Generic cisplatin is cheap and on-label for
high-volume curative regimens. PA friction comes from the combo biologics (pembrolizumab in KEYNOTE-048
HNSCC, KEYNOTE-590 esophageal, KEYNOTE-826 cervical) where biomarkers (PD-L1 CPS, MSI-H/dMMR) and line of
therapy drive approval. Schedule biomarker testing early for any patient who may go on cisplatin +
checkpoint inhibitor.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J9060
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions · ASP updated quarterly by CMS — next update: July 1, 2026 for Q3
ASP + 6%
$2.166
per 10 mg unit (pre-sequestration ~2%)
185 mg dose (100 mg/m² / 1.85 m²)
$41.15
19 units × ASP+6%
100 mg standard dose
$21.66
10 units × ASP+6%
Annualized cisplatin + RT HNSCC course drug cost: 3 cycles × ~$41.15 (1.85 m²
patient on 100 mg/m²) = ~$123 in cisplatin acquisition for an entire curative HNSCC course. The
administration codes (96413 + 96415 + 96360/96361 hydration + 96367 anti-emetic sequencing) and supportive
care generate substantially more revenue than the cisplatin itself. This is the operational reality for
generic cytotoxic chemotherapy: drug margin is minimal; encounter complexity is the revenue.
Coverage
No NCD specific to cisplatin. Coverage falls under MAC LCDs for chemotherapy + the generic drug-coverage framework. All MACs cover J9060 for FDA-approved on-label indications (HNSCC, cervical, NSCLC, SCLC, bladder, testicular, mesothelioma, ovarian) and NCCN-compendium-supported off-label uses with appropriate ICD-10 documentation.
Code history
- J9060 — "Injection, cisplatin, powder or solution, 10 mg" (permanent)
- 10 mg unit basis is the original platinum unit basis; carboplatin J9045 is per 50 mg, oxaliplatin J9263 is per 0.5 mg. The three platinums each have different unit math — verify per drug.
Platinum class comparison
| Drug | HCPCS | Unit basis | Generation | Primary indications | Hallmark toxicity |
|---|---|---|---|---|---|
| Cisplatin | J9060 |
10 mg | 1st gen | Testicular GCT, HNSCC + RT, cervical + RT, NSCLC, bladder, mesothelioma | Nephrotoxicity (hydration required), ototoxicity, severe emesis (HEC) |
| Carboplatin | J9045 |
50 mg | 2nd gen | Ovarian, lung, breast, head & neck | Myelosuppression (esp. thrombocytopenia); much less nephro/oto/emetogenic than cisplatin |
| Oxaliplatin | J9263 |
0.5 mg | 3rd gen | Colorectal, gastric, pancreatic (FOLFOX, FOLFIRINOX, FLOT) | Peripheral neuropathy (acute cold-triggered + chronic cumulative); anaphylaxis (boxed) |
Class context: Cisplatin retains primacy in curative-intent regimens for testicular GCT,
locally advanced HNSCC + RT, locally advanced cervical + RT, and muscle-invasive bladder where carboplatin
is non-equivalent. Carboplatin substitution is regimen-defining, not cosmetic. Oxaliplatin is the platinum
for GI cancers and is not a cisplatin substitute. The three platinums are not interchangeable
— substituting one for another changes outcomes.
Patient assistance Verified May 2026
Cisplatin is generic and no longer marketed under the originator BMS Platinol brand — there is no manufacturer patient assistance program (PAP) for cisplatin. Patient OOP support routes through oncology cost-sharing foundations and indication-specific funds.
- PAN Foundation: panfoundation.org / 1-866-316-7263 — verify open disease-state funds for HNSCC, cervical, bladder, NSCLC, testicular, mesothelioma quarterly
- HealthWell Foundation: healthwellfoundation.org / 1-800-675-8416 — cost-sharing assistance across multiple oncology funds
- CancerCare Co-Payment Assistance Foundation: cancercarecopay.org / 1-866-552-6729 — co-pay assistance for chemotherapy patients
- Co-Pay Relief (PAF): Patient Advocate Foundation / copays.org / 1-866-512-3861
- NeedyMeds: needymeds.org — aggregator of patient assistance programs across generic chemo agents
- Generic manufacturer support: Hospira/Pfizer, Teva, Accord, and Fresenius Kabi may operate institutional patient-assistance programs reachable through dispensing pharmacy; not a public consumer-facing PAP for cisplatin
Generic cisplatin is rarely the OOP burden. Patient cost concerns on cisplatin regimens
typically come from the combo biologics (pembrolizumab, bevacizumab), the hospital outpatient facility
fees, and Medicare Part B 20% admin coinsurance on the 6–8 hour encounter. Run a CareCost Estimate to
see total cycle OOP including drug, admin, hydration, anti-emetic premeds, and supportive care —
J9060 pre-loaded.
Phase 4
Safety, warnings & denials
Nephrotoxicity is dose-limiting. Ototoxicity is irreversible. Emesis without triple premed is severe.
Toxicity profile — what payers want documented FDA label + NCCN verified May 2026
BOXED WARNING — NEPHROTOXICITY, PERIPHERAL NEUROPATHY, NAUSEA AND VOMITING, MYELOSUPPRESSION.
Current generic cisplatin labels (Teva, Hospira/Pfizer, Accord, WG Critical Care, Fresenius Kabi) all carry
a four-element boxed warning: (1) severe renal toxicity / acute renal failure — mitigated by mandatory
saline hydration; (2) dose-related peripheral neuropathy that worsens with repeated courses; (3) severe
nausea and vomiting — HEC, requires NK1 + 5-HT3 + dexamethasone triple premed; (4) severe
myelosuppression with fatalities due to infection. Ototoxicity and hypersensitivity sit in W&P (sections 5.5,
5.6), not in the boxed warning — but the FDA-approved sodium thiosulfate (Pedmark, J9248) for
pediatric ototoxicity prevention raises ototoxicity to a payer-documentation issue regardless.
Nephrotoxicity — the dose-limiting toxicity
- Dose-dependent, cumulative, can be acute (AKI) or chronic (CKD)
- Mitigated by 1–2 L pre + post saline hydration with target urine output ≥ 100 mL/hr
- Hypomagnesemia is universal — replace 8–20 mEq MgSO₄ in the hydration bag
- Baseline CrCl required before each cycle (most regimens require CrCl ≥ 50–60 mL/min)
- Concurrent nephrotoxins (aminoglycosides, NSAIDs, IV contrast) increase risk — document avoidance
- If AKI develops: hold cisplatin, reduce dose, or substitute carboplatin (regimen-defining)
- ICD-10 N14.1 (drug-induced AKI) supports nephrology consultation claims
Ototoxicity — often irreversible
- Cumulative dose-dependent; risk rises sharply at > 200 mg/m² cumulative
- High-frequency sensorineural hearing loss; often permanent
- Baseline audiogram before therapy; follow-up audiogram at cumulative dose > 200 mg/m² or with new symptoms
- Pediatric audiometry every cycle (language-acquisition stakes)
- FDA-approved sodium thiosulfate (Pedmark, J9248) for ototoxicity prevention in pediatric patients with localized non-metastatic solid tumors (approved 2022)
- ICD-10 H90.3 / H90.41 / H93.13 (tinnitus) supports otologic follow-up
Severe emesis (highly emetogenic chemotherapy / HEC)
- Cisplatin is the prototypical HEC agent — emesis rate without prophylaxis is > 90%
- Standard premed: NK1 RA + 5-HT3 RA + dexamethasone ± olanzapine per ASCO/NCCN antiemesis guidelines
- Without proper premedication, severe nausea and vomiting can drive emergency-department visits and hospitalization
- Bill anti-emetic IV premeds via
96367per agent (sequential non-chemo infusion) - Document each anti-emetic in the chemo order set; payer audits sometimes target inadequate antiemesis premed for HEC agents
Peripheral neuropathy
- Sensory neuropathy in ≥ 50% with cumulative doses > 300 mg/m²
- Less prominent than oxaliplatin acute cold-triggered pattern; cisplatin neuropathy is chronic cumulative only
- Stocking-glove paresthesia + loss of vibratory sense + Lhermitte sign described
- ICD-10 G62.0 supports neurology referral and management
Myelosuppression
- Modest neutropenia and thrombocytopenia — less severe than carboplatin
- CBC required prior to each cycle
- G-CSF support typically not required for cisplatin alone; required for combination regimens with myelosuppressive partners
Hypersensitivity (less than oxaliplatin)
- Cisplatin hypersensitivity is less common than oxaliplatin (where anaphylaxis is the boxed warning); cisplatin hypersensitivity sits in W&P (section 5.5), not in cisplatin's four-element boxed warning
- When it occurs, it tends to be after multiple cycles (cumulative sensitization)
- Cross-reactivity between platinums (cisplatin ↔ carboplatin ↔ oxaliplatin) is real — document any prior platinum reaction history
- If reaction occurs: T80.52XA (anaphylactic reaction due to therapeutic drug, initial encounter)
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| Inappropriate JZ/JW modifier | JZ or JW appended to a multi-dose vial NDC | Remove modifier; J9060 multi-dose NDCs are excluded from CMS JW/JZ policy. Verify container type per actual dispensed NDC. |
| Wrong unit basis | Billed J9060 in mg instead of 10 mg units (10x overpayment) or in vials (undercount) | Divide administered mg by 10, round up. Re-submit corrected units. |
| Wrong admin code (96365) | Therapeutic IV billed instead of chemo IV for cisplatin | Resubmit with 96413 + 96415. Cisplatin is true cytotoxic chemo. |
| Missing hydration codes | Pre/post-hydration not billed | Add 96360 + 96361 for each hr of saline; document start/stop times in record. |
| Missing anti-emetic premed sequencing | NK1 RA + 5-HT3 RA + dex billed as one line | Bill 96367 for each sequential anti-emetic; HEC premed is medically necessary documentation. |
| Baseline CrCl not documented | Renal function lab not in PA submission | Submit serum creatinine + calculated CrCl from within 30 days of treatment; CrCl < 50–60 mL/min may require dose reduction or carboplatin substitution. |
| Baseline Mg not documented | Hypomagnesemia not assessed before cycle | Submit serum Mg — supports Mg replacement in hydration bag. |
| Audiogram not on file (high cumulative dose) | Cumulative dose > 200 mg/m² without baseline + follow-up audiogram | Order audiogram before next cycle; document baseline and follow-up. |
| Histology not documented (NSCLC) | Cisplatin + pemetrexed approved for non-squamous only | Submit pathology with non-squamous (adenocarcinoma, large cell, NOS-not-squamous) histology designation. |
| Combo biologic PA missing | Cisplatin approved but pembrolizumab/bevacizumab/cetuximab not | Submit separate PA for each combo agent with required biomarker (PD-L1 CPS, MSI-H/dMMR) and line of therapy documentation. |
| NDC mismatch on lot | Billed Hospira NDC but Accord or Fresenius Kabi lot dispensed | Pull NDC from actual lot at admin time. Generic interchange happens at the buy-and-bill level. |
| Solvent error | Pharmacy used D5W instead of NS (oxaliplatin mix-up) | Cisplatin is saline-compatible; D5W is acceptable per some FDA labels but NS is conventional. Pharmacy verification before infusion. |
Frequently asked questions
What is the HCPCS code for cisplatin?
Cisplatin (Platinol originator + all generics) is billed under HCPCS J9060 —
"Injection, cisplatin, powder or solution, 10 mg." 1 unit = 10 mg. A 100 mg/m² dose
for a 1.85 m² patient = 185 mg = 19 units. Convert mg to units by dividing by 10
and rounding up.
How is cisplatin different from carboplatin?
Both are platinum-coordination cytotoxics, but they are not interchangeable. Cisplatin (J9060, 1st gen) is more nephrotoxic, more emetogenic, more ototoxic, and requires aggressive 1–2 L IV hydration before and after infusion — extending chair time substantially. Carboplatin (J9045, 2nd gen) is more myelosuppressive (especially thrombocytopenia) but needs no hydration. Cisplatin retains primacy in testicular germ cell tumors (curative), HNSCC + RT, cervical + RT, NSCLC where carboplatin is non-equivalent, and bladder cancer. Carboplatin substitution is regimen-defining; payers may require documentation of cisplatin failure or contraindication for substitution.
Why does cisplatin require so much hydration?
Cisplatin is excreted by the kidneys, where platinum accumulates in proximal tubular cells and causes dose-limiting acute kidney injury. Aggressive saline diuresis dilutes intratubular platinum and forces urine output, reducing nephrotoxicity. Standard protocol: 1–2 L of 0.9% NaCl IV over 2–4 hours pre-infusion, cisplatin infusion over 1–2 hours, then 1–2 L NS over 2–6 hours post-infusion, with target urine output of 100 mL/hr or greater for 6–8 hours. Many regimens add 8–20 mEq magnesium sulfate. The full encounter (pre-hydration + cisplatin + post-hydration) commonly runs 6–8 hours of chair time and drives the strong HOPD site-of-care preference.
What administration CPT do I use for cisplatin?
Chemotherapy admin codes for the drug itself: 96413 for hour 1 + 96415 × 1
for hour 2 if infusion exceeds 1 hour. Hydration codes for the pre/post saline: 96360
(initial 31 min–1 hr) + 96361 (each additional hour). Anti-emetic premeds:
96367 for each sequential non-chemo IV premed (fosaprepitant, palonosetron, dex), or
96375 for IV push (ondansetron). For combination regimens, subsequent chemo agents bill
96417 (each additional sequential chemo infusion). Do NOT bill 96365 for the
cisplatin itself.
Do I bill JZ or JW for cisplatin?
Usually no. Standard U.S. cisplatin generic NDCs are preserved multi-dose vials (50 mg/50 mL, 100 mg/100 mL) — CMS's JW/JZ single-dose container policy does NOT apply to multi-dose containers. Do not auto-append JZ or JW to J9060 lines without confirming the actual dispensed NDC is a single-dose container. If your facility uses a verified single-dose cisplatin NDC, apply the same JZ-on-administered / JW-on-waste convention as oxaliplatin. But verify container type for every lot.
What is the Medicare reimbursement for J9060?
For Q2 2026, the Medicare Part B payment limit for J9060 is approximately $2.166 per 10 mg unit (ASP + 6%). A 100 mg/m² dose for a 1.85 m² patient (185 mg = 19 units rounded up) costs about $41.15. A standard 100 mg flat dose (10 units) is roughly $21.66. Annualized 3-cycle cisplatin + RT HNSCC course drug cost: ~$123. Among the lowest cytotoxic per-mg costs because cisplatin has been generic since the 1990s and the BMS Platinol brand is discontinued.
Which combination regimens use cisplatin?
Curative-intent regimens: BEP / EP for testicular germ cell tumor (cisplatin 20 mg/m²/day × 5), cisplatin + concurrent radiation for locally advanced HNSCC and cervical cancer (100 mg/m² q3w), EP for limited-stage SCLC with thoracic RT (75–80 mg/m² q3w). Palliative: cisplatin + pemetrexed for non-squamous NSCLC and mesothelioma, cisplatin + gemcitabine (GC) for bladder, cisplatin + 5-FU ± Keytruda for HNSCC and gastric, cisplatin + paclitaxel + bevacizumab ± Keytruda for cervical.
What is the cumulative cisplatin dose limit for ototoxicity?
Cisplatin ototoxicity is dose-dependent and often irreversible. Baseline audiogram before therapy; follow-up audiogram at cumulative dose > 200 mg/m² or with new symptoms (tinnitus, hearing loss). Pediatric protocols (germ cell, neuroblastoma, hepatoblastoma) include audiometry every cycle. FDA-approved Pedmark (sodium thiosulfate, J9248) in 2022 for ototoxicity prevention in pediatric patients with localized non-metastatic solid tumors.
How is cisplatin dosed in pediatric germ cell tumor regimens?
Pediatric BEP (POG/COG): cisplatin 20 mg/m²/day IV days 1–5 of each 21-day cycle (rather than adult single-dose 100 mg/m² on day 1). Cycles typically 3–4 depending on stage. Pediatric protocols add audiometry every cycle and consider Pedmark for ototoxicity prevention in localized non-metastatic disease. Weight- and BSA-based dosing is best handled by oncology pharmacy with double-checked calculations because the 5-day fractionated schedule materially increases the risk of dosing math errors.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- DailyMed — Cisplatin (multiple generic SPLs: Hospira/Pfizer, Teva, Accord, WG Critical Care, Fresenius Kabi)
- FDA Drugs@FDA — Platinol (cisplatin) NDA 018057
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J9060 reference
- CMS — JW and JZ Modifier FAQs
- NCCN Clinical Practice Guidelines — Testicular Cancer (v.2026)
- NCCN Clinical Practice Guidelines — Head and Neck Cancers (v.2026)
- NCCN Clinical Practice Guidelines — Cervical Cancer (v.2026)
- NCCN Clinical Practice Guidelines — Non-Small Cell Lung Cancer (v.2026)
- NCCN Clinical Practice Guidelines — Bladder Cancer (v.2026)
- NCCN Clinical Practice Guidelines — Antiemesis (v.2026)
- FDA — Pedmark (sodium thiosulfate, J9248) label
- UnitedHealthcare — Oncology Medication Clinical Coverage Policy
- FDA National Drug Code Directory
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| NCCN regimens | Semi-annual | Reviewed against NCCN H&N, Testicular, Cervical, NSCLC, Bladder, SCLC, Mesothelioma updates. |
| HCPCS / CPT / modifier rules | Annual | Reviewed against CMS HCPCS quarterly files and AMA CPT releases. |
| NDC, dosing, FDA label | Event-driven | Tied to FDA label revision date and generic NDC additions/withdrawals. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA generic SPLs,
CMS, NCCN guidelines, payer policy documents — all linked above). Editorial review in progress. Until
that review is complete, treat this as a draft reference and verify each cited source for high-stakes
claims.
Change log
- — SME audit pass. Corrected boxed-warning status: current generic cisplatin labels (Teva, Hospira/Pfizer, Accord, etc.) carry a four-element boxed warning (NEPHROTOXICITY, PERIPHERAL NEUROPATHY, NAUSEA AND VOMITING, MYELOSUPPRESSION) — page previously stated "no boxed warning." DailyMed Teva setid verified: a440f077-46f6-4688-a209-65bce38d1c92 (Rev. Aug 2022).
- — Initial publication. ASP data: Q2 2026. NCCN: v.2026 H&N, Testicular, Cervical, NSCLC, Bladder, SCLC, Antiemesis. FDA label: generic cisplatin SPLs (Platinol originator discontinued). Curative-intent + palliative combination regimens documented (BEP, EP, cisplatin + RT, cisplatin + 5-FU, cisplatin + pemetrexed, GC, MVAC, cisplatin + Keytruda). Hydration protocol, nephrotoxicity, ototoxicity, HEC emetogenicity covered. Multi-dose vial JZ/JW caveat included. Platinum class comparison vs carboplatin (J9045) and oxaliplatin (J9263).
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Combo regimens are verified against NCCN guideline current version. We do not paraphrase from billing-software vendor blogs.