Poteligeo (mogamulizumab-kpkc) — HCPCS J9204

CareCost Estimate · Billing Cheat Sheet

Kyowa Kirin, Inc. 20 mg / 5 mL single-dose vial IV infusion ≥60 min Reviewed: May 22, 2026 ASP: Q2 2026

HCPCS

J9204

1 mg = 1 unit

Dose

1 mg/kg

q1w × 4 → q2w

Modifier

JZ + JW

20 mg vial / weight-based

Admin CPT

96413

Chemo IV, 60 min

Medicare ASP+6%

$253.467

/mg · $17,742.69 (70 mg)

Codes & NDC

HCPCS	`J9204` — "Injection, mogamulizumab-kpkc, 1 mg" (permanent, eff. 1/1/2020)
NDC	`42747-761-50` (10) / `42747-0761-50` (11) — N4 qualifier
Vial	20 mg / 5 mL (4 mg/mL) single-dose; preservative-free
Manufacturer	Kyowa Kirin, Inc. (no biosimilars)
Benefit	Medical (provider buy-and-bill); in-clinic only

Dosing — cycle 1 vs cycle 2+

Cycle	Dose	Days	Infusions
Cycle 1	1 mg/kg IV	1, 8, 15, 22	4 weekly
Cycle 2+	1 mg/kg IV	1, 15 (q28d)	2 per cycle

Infuse over ≥60 min through 0.22-micron in-line filter
Dilute in 0.9% NaCl to 50–250 mL; gently invert (do NOT shake)
Continue until disease progression or unacceptable toxicity

JZ + JW worked example (70 kg)

70 kg × 1 mg/kg = 70 mg dose
4 × 20 mg vials drawn = 80 mg
Line 1: J9204 × 70 with JZ
Line 2: J9204 × 10 with JW

One of JZ or JW required on every J9204 claim (CMS single-dose container policy, 7/1/2023). Missing = auto denial.

Administration codes

Code	When
`96413`	Chemo IV, ≤1 hr — primary (60-min infusion fits)
`96415`	+each additional hr — only if documented >60 min
`96365`	NOT appropriate — chemo admin per CPT for hem mAb

ICD-10 — CTCL (label only)

Code	For
`C84.0x`	Mycosis fungoides (MF) by site
`C84.1x`	Sézary syndrome (SS) by site
`C84.A`	Other CTCL variants — OFF-label
`Z51.11`	Encounter for antineoplastic chemotherapy (pair on every admin line)

PA requires: pathology, TNMB stage, Sezary cell count (SS), ≥1 prior systemic therapy with dates + outcome.

Site of care

Setting	POS	Notes
Onc office	11	Preferred for stable maint.
Freestanding infusion (AIC)	49	Acceptable
HOPD (on-campus)	22	Common for cycle 1
HOPD (off-campus)	19	Acceptable
Patient home	12	NOT appropriate

Top denials

#1: MF/SS pathology + TNMB stage + Sezary cell count not on file
≥1 prior systemic therapy not documented
Premedication (acetaminophen + antihistamine) not in chart for cycle 1
JW missing on partial-vial waste
Wrong admin code (96365 instead of 96413)
Off-label CTCL variant (C84.A) without peer-to-peer

Medicare (Q2 2026)

Field	Value
ASP + 6%	$253.467 / mg (eff. 4/1 – 6/30/2026)
70 mg dose (70 kg)	$17,742.69
Cycle 1 (4 doses)	$70,970.76
Each q2w cycle (2 doses)	$35,485.38
Next ASP update	July 1, 2026 (Q3)

Patient assistance — Kyowa Kirin Patient Support

Phone: 1-844-768-3544 (KKPS)
Commercial copay: Poteligeo Co-Pay Assistance Program
PAP: free drug for uninsured/underinsured
Foundations: PAF, HealthWell, CancerCare, LLS (verify CTCL/lymphoma funds quarterly)
Web: poteligeo-hcp.com / kkpatientsupport.com

W&P (label, no formal black-box): serious infusion reactions (~33% cycle 1), severe dermatologic reactions (SJS/TEN), infection, autoimmune complications, increased severe acute GVHD if used pre-allogeneic HSCT.

Sources: FDA label (BLA 761051, Aug 2018, rev. 2024), MAVORIC (Lancet Oncol 2018), Kyowa Kirin Patient Support, CMS ASP Q2 2026, NCCN T-cell lymphoma, UHC/Aetna oncology drug policies. carecostestimate.com/drugs/poteligeo