Irinotecan (Camptosar generic) — HCPCS J9206
CareCost Estimate · Billing Cheat Sheet
Pfizer originator (Camptosar) + multi-generic
20 mg/mL injection · 40, 100, 300, 500 mg single-dose vials
IV infusion 90 min · FOLFIRI q14d / mono q21d
Reviewed: May 22, 2026
ASP: Q2 2026
HCPCS
J9206
20 mg = 1 unit (NOT J9205)
FOLFIRI dose
324 mg
180 mg/m² × 1.8 m² BSA
Modifier
JZ / JW
JZ if no waste; JW for SDV waste
Admin CPT
96413+96415
90-min chemo IV
Medicare ASP+6%
$1.532
/ 20 mg unit · $24.82 / 324 mg
J9206 ≠ J9205. J9206 = conventional irinotecan / Camptosar / generic ($1.532 per 20 mg unit, ~$0.077/mg). J9205 = Onivyde liposomal pegylated ($66.374/mg). Onivyde is ~860× more expensive per mg. Different drug, different toxicity, different regimens (FOLFIRI/FOLFIRINOX vs NALIRIFOX/NAPOLI).
Codes & NDC (multi-generic)
| HCPCS | J9206 — "Injection, irinotecan, 20 mg" (permanent; effective 1996 with Camptosar approval) |
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| Vial sizes | 40 mg / 2 mL, 100 mg / 5 mL, 300 mg / 15 mL, 500 mg / 25 mL @ 20 mg/mL |
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| NDC (Pfizer/Hospira) | 0009-7530-02 100 mg; 0009-7959-01 300 mg |
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| NDC (Accord) | 16729-0260-05 100 mg; 16729-0260-15 300 mg |
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| NDC (Fresenius Kabi) | 63323-0193-05 100 mg |
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| NDC (Teva) | 0703-4654-01 40 mg; 0703-4655-01 100 mg |
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| NDC (Sandoz) | 0781-3088-95 100 mg |
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| Reference comparison | Onivyde liposomal = J9205 (Ipsen, only), 1 mg per unit, $66.374/mg |
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| Benefit | Medical (provider buy-and-bill); Part B for Medicare |
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Update NDC on procurement rotation. Multi-source generic — the NDC on the claim must match the vial actually used.
FOLFIRI — 1L metastatic CRC
| Drug | Dose | Time | CPT |
|---|
| Irinotecan (J9206) | 180 mg/m² | 90 min IV | 96413+96415 |
| Leucovorin (J0640) | 400 mg/m² | concurrent / 30 min | 96417 |
| 5-FU (J9190) bolus | 400 mg/m² | IV push | 96409 |
| 5-FU (J9190) CIVI | 2,400 mg/m² | 46 hr CIVI | 96416 + pump |
Cycle: Day 1 every 14 days · Add-ons: bevacizumab; cetuximab/panitumumab if RAS/BRAF-WT
FOLFIRINOX — pancreatic 1L
- Oxaliplatin 85 mg/m² + irinotecan 180 mg/m² + leucovorin 400 + 5-FU 400 bolus + 2,400 over 46 hr; q14d
- mFOLFIRINOX: drop 5-FU bolus; reduce irinotecan to 150 mg/m² (better tolerated)
- Performance status ECOG 0–1 required by most payers
Monotherapy / other regimens
- 2L CRC mono: 350 mg/m² IV over 90 min q21d (630 mg for BSA 1.8 m² = 31.5 units)
- Weekly mono (legacy): 125 mg/m² weekly × 4, then 2-week rest
- Irinotecan + cetuximab: 180 mg/m² q14d + cetuximab; KRAS/NRAS/BRAF-WT mCRC post-FOLFIRI
- Pediatric (off-label): VI (rhabdo) 50 mg/m² d1-5 q21d; IT (Ewing) 20 mg/m² d1-5 × 2 wk + temozolomide
UGT1A1 testing & dose mod
| Genotype | Freq | FOLFIRI | Mono q21d |
|---|
| *1/*1 (wt) | ~45-50% | 180 mg/m² | 350 mg/m² |
| *1/*28 (het) | ~40-45% | 180 mg/m² | 350 mg/m² |
| *28/*28 (hom) | ~10% | 150 mg/m² | 250-300 mg/m² |
Test pre-treatment: CPT 81350 (UGT1A1 gene analysis). Several BCBS plans + UHC oncology require UGT1A1 in PA for high-dose regimens. Send-out lab, 5–10 day TAT, valid for life. Covers downstream Onivyde / Trodelvy too.
Administration & modifiers
| Code | When |
|---|
96413 | Initial 1 hr chemo IV (primary, irinotecan) |
96415 × 1 | Additional 30 min (90-min infusion) |
96417 | Each additional sequential drug (leucovorin, oxaliplatin) |
96409 | IV push (5-FU 400 mg/m² bolus) |
96416 | 5-FU 46-hr pump start |
96365 | NOT appropriate — irinotecan is chemo |
JZ vs JW (CMS req July 2023): Every SDV claim must carry one. JZ when no waste (multi-vial assembly hits exact mg, or multi-dose preserved vial). JW on separate line for any discarded mg from single-dose vials. Worked: 324 mg = 300 + 40 vials → 16 mg waste → JZ line 16.2u administered + JW line 0.8u (16 mg).
ICD-10 by indication
| Code | For |
|---|
C18.0-C18.9 | Colon (site-specific) — FOLFIRI |
C19, C20 | Rectosigmoid junction, rectum — FOLFIRI |
C25.0-C25.3, C25.7-C25.9 | Pancreas (exocrine) — FOLFIRINOX |
C25.4 | NOT for FOLFIRINOX — endocrine PNETs (different disease) |
C16.x | Gastric — FOLFIRI off-label per NCCN |
C15.x | Esophageal — FOLFIRI off-label per NCCN |
C49.x | Soft-tissue sarcoma (rhabdo, Ewing) — pediatric off-label |
C40.x / C41.x | Bone sarcoma (Ewing) — pediatric off-label |
C77-C79 | Secondary (nodal / digestive / other mets) |
Diarrhea management (BOXED warn)
| Acute (cholinergic) | Delayed-onset |
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| Time | <24 hr (often during) | Days 3–10 |
| Mechanism | AChE inhibition (parent) | SN-38 gut tox |
| Treatment | Atropine 0.25-1 mg IV/SC | Loperamide high-dose: 4 mg load, 2 mg q2h |
| Severity | 9% incidence per label | G3+ in ~14% (BOXED) |
Hospitalize G3+ delayed. Reduce dose one level next cycle (FOLFIRI 180→150; mono 350→250-300). Atropine + loperamide must be available at every infusion. Cholinergic same-day E/M: modifier 25.
Payer requirements (May 2026)
| Payer | PA | Documentation |
|---|
| UnitedHealthcare | Yes (regimen) | Indication + FOLFIRI vs FOLFIRINOX vs mono + line of therapy + concurrent biologic PA; UGT1A1 for high-dose |
| Aetna | Yes (regimen) | Path report, stage, line of therapy, prior regimens, UGT1A1 recommended |
| BCBS plans | Yes | Per NCCN + FDA label; select plans require UGT1A1 |
| Cigna | Yes (pathway) | NCCN pathway + biomarkers (RAS/BRAF/MSI for CRC EGFR therapies) |
| Medicare Part B | No (FFS) | On-label + NCCN-supported off-label covered under generic chemo LCDs |
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $1.532 per 20 mg unit (~$0.077/mg, eff. 4/1–6/30/2026) |
| FOLFIRI 324 mg (BSA 1.8) | $24.82 (16.2 units administered) |
| + ~16 mg waste reimbursement | ~$1.23 — bill JW separate line |
| Mono 630 mg (BSA 1.8) | $48.26 (31.5 units administered) |
| Annual FOLFIRI (26 cycles) | ~$645/yr irinotecan component only |
| vs J9205 Onivyde liposomal | $66.374/mg ($5,973.66 / 90 mg dose) — ~860× per-mg cost |
Patient assistance (foundation-driven, generic)
- CancerCare: 1-866-552-6729 (cancercare.org)
- PAN Foundation: 1-866-316-7263 (panfoundation.org) — verify open CRC / pancreatic funds quarterly
- HealthWell Foundation: 1-800-675-8416 (healthwellfoundation.org)
- Patient Advocate Foundation Co-Pay Relief: 1-866-512-3861 (copays.org)
- Concurrent biologic programs: Avastin Access Solutions, ErbituxAccess, Vectibix Patient Resources — biologic typically dominates patient OOP, not irinotecan
Pending SME review. Staff-authored from FDA Camptosar label, CMS Q2 2026 ASP, NCCN Colon v2.2026 + Pancreatic v2.2026, multi-generic ANDA labels, CPIC UGT1A1 guideline, UHC oncology LCDs. Verify cited sources for high-stakes claims.