Firmagon (degarelix) — HCPCS J9155

CareCost Estimate · Billing Cheat Sheet

Ferring Pharmaceuticals 80 mg & 120 mg single-dose vials (lyophilized) SC abdomen — 240 mg loading + 80 mg monthly Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS

J9155

1 mg = 1 unit

240 units

2 × 120 mg SC, 2 sites

Maintenance

80 units

80 mg SC monthly

Admin CPT

96402

Chemo SC, hormonal

Medicare ASP+6%

$4.458

/mg · $356.64/80 mg

NO TESTOSTERONE FLARE — the Firmagon advantage. GnRH antagonist (not agonist). Suppresses testosterone within days without the 1–2 wk surge that plagues Lupron/Eligard. Critical in patients with bone metastases, spinal cord compression risk, or urinary obstruction. No antiandrogen co-administration needed (no flare to block).

Codes & NDC

HCPCS	`J9155` — "Degarelix injection" (permanent)
NDC (loading)	`55566-8303-01` — 120 mg single-dose vial kit (use 2 per loading visit)
NDC (maint)	`55566-8203-01` — 80 mg single-dose vial kit (1 per monthly visit)
Vial	Lyophilized powder + sterile water diluent in kit; reconstitute at point of administration
Benefit	Medical (provider buy-and-bill)

Dosing

Loading (Day 0): 240 mg SC = 2 × 120 mg injections at 2 different abdominal sites, same visit
Maintenance (Day 28+): 80 mg SC monthly, single injection in abdomen
Reconstitute powder + sterile water immediately before injection; inject within 1 hour
Year-1 total: 1 loading + 11 monthly = 1,120 units / ~$4,993 (Medicare ASP+6%)

GnRH analog class — ADT for prostate cancer

Drug	HCPCS	Class / Route	Flare
Firmagon	`J9155`	Antagonist · SC monthly	No
Lupron Depot	`J1950`	Agonist · IM q1/3/4/6mo	Yes
Eligard	`J9217`	Agonist · SC depot	Yes
Trelstar	`J3315`	Agonist · IM monthly	Yes
Zoladex	`J9202`	Agonist · SC implant	Yes
Orgovyx	pharmacy	Antagonist (oral)	No

Administration & modifiers

Code	When
`96402`	Chemo SC, hormonal antineoplastic (primary). Bill ONCE per visit even with 2 loading injections.
`96401`	Wrong — non-hormonal SC chemo. Use 96402.
`96372`	Therapeutic SC. Some payers accept; 96402 preferred for prostate ca.

JZ on virtually every claim — fixed dosing, no waste. JW rarely if ever applies. CMS requires JZ or JW on every single-dose claim since 7/1/2023.

ICD-10 — prostate cancer

Code	For
`C61`	Malignant neoplasm of prostate (primary — required)
`C77.5`	Pelvic nodal mets
`C79.51`	Bone mets (Firmagon-preferred scenario)
`C79.52`	Bone marrow mets
`R97.21`	Rising PSA post-treatment
`Z19.1` / `Z19.2`	Hormone sensitive / resistant status

FDA-approved only for advanced prostate cancer. Off-label use will not have an applicable C-code.

Payer requirements (May 2026)

Payer	PA	Step / Notes
UnitedHealthcare	Yes	Some plans require GnRH agonist trial first; bypass with flare-vulnerable docs
Aetna	Yes	Baseline T + PSA + ECG required
BCBS plans	Yes	Aligned with NCCN Prostate Ca guidelines
Medicare LCDs	No PA	Coverage for FDA-approved indication w/ C61

Document flare-avoidance rationale (bone mets, spinal cord compression risk, urinary obstruction) to bypass agonist-first step therapy.

Medicare reimbursement (Q2 2026)

Field	Value
ASP + 6%	$4.458 / mg (effective 4/1 – 6/30/2026)
240 mg loading	$1,069.92 (240 × $4.458)
80 mg monthly	$356.64 (80 × $4.458)
Year-1 total (1 load + 11 maint)	~$4,993

Site of care

Setting	POS	Notes
Urology / oncology office	11	Preferred — SC injection, no chair time
Ambulatory infusion suite	49	Acceptable
Hospital outpatient	19/22	Disfavored for routine maintenance
Patient home	12	Uncommon — reconstitution complexity

Patient assistance — Ferring

Phone: 1-888-FERRING (1-888-337-7464)
Firmagon Co-pay Program: commercial copay support (excludes Medicare/Medicaid/federal)
Patient Assistance: free product for uninsured/underinsured
Medicare patients: refer to PAN, HealthWell, CancerCare, PAF
Web: firmagon.com

W&P (no Boxed warning): injection-site reactions ~40% (visible nodule lasting weeks — the most-noticed AE), QT/QTc prolongation (baseline + ongoing ECG), hepatic dysfunction (LFT monitoring), hot flashes, decreased bone density (long-term).

Pending SME review. Staff-authored from FDA, CMS, Ferring, payer, NCCN/AUA sources. Verify high-stakes claims at the linked sources.

Sources: Ferring HCP page (2026), FDA label (NDA 022201, Dec 2008 + revisions), CMS ASP Q2 2026, UHC/Aetna prostate cancer policies, NCCN Prostate Ca Guidelines, AUA Advanced Prostate Cancer Guideline. carecostestimate.com/drugs/firmagon