Imfinzi (durvalumab) — HCPCS J9173

CareCost Estimate · Billing Cheat Sheet

AstraZeneca 120 mg/2.4 mL & 500 mg/10 mL single-dose vials (50 mg/mL) IV infusion · 60 min first dose, ≥30 min subsequent Reviewed: May 2, 2026 ASP: Q2 2026

HCPCS

J9173

10 mg = 1 unit

Std flat dose

150 units

1,500 mg q4w · 3 vials

Modifier

SDV, no waste at fixed dose

Admin CPT

96413

+96415 ea addl hr

Medicare ASP+6%

$86.146

/10 mg · $12,921.90 / 1,500 mg

Codes & NDC

HCPCS	`J9173` — "Inj., durvalumab, 10 mg" (permanent; 1 unit = 10 mg)
NDC (120 mg)	`00310-4500-12` (10) / `00310-4500-12` (11) — N4 qualifier
NDC (500 mg)	`00310-4611-50` (10) / `00310-4611-50` (11) — N4 qualifier
Vials	120 mg / 2.4 mL & 500 mg / 10 mL single-dose (50 mg/mL)
Disambig	Imjudo (tremelimumab-actl, `J9347`) is AZ's CTLA-4 inhibitor — frequently combined with Imfinzi (HCC, NSCLC) but billed separately.
Class	Anti-PD-L1 mAb (vs anti-PD-1: Keytruda, Opdivo, Libtayo, Jemperli)

Dosing — multi-indication

Indication	Regimen
Stage III NSCLC (PACIFIC)	10 mg/kg q2w or 1,500 mg q4w post-CRT
LS-SCLC (ADRIATIC, 2024)	1,500 mg q4w post-CRT
ES-SCLC (1L)	1,500 mg + chemo q3w → 1,500 mg q4w
HCC (HIMALAYA STRIDE)	1,500 mg + Imjudo 300 mg single dose → Imfinzi 1,500 mg q4w
Biliary tract (1L)	1,500 mg + gem/cis q3w → 1,500 mg q4w
Endometrial (1L)	1,500 mg + chemo q3w → 1,500 mg q4w
Resectable NSCLC (AEGEAN, 2024)	1,500 mg + chemo q3w ×4 (neoadj) → 1,500 mg q4w ×12 (adj)
Urothelial (post-platinum)	10 mg/kg q2w (older indication)

Two unit-math worlds: the 1,500 mg flat dose = 150 units (3 × 500 mg vials, no waste). Weight-based 10 mg/kg PACIFIC/urothelial = bill actual mg /10; expect partial-vial JW waste.

Administration & modifiers

Code	When
`96413`	Chemo IV admin, up to 1 hr (initial) — first dose 60 min
`96415`	Each additional hr (rare for mono; combo with chemo extends chair time)
`96365`	Not appropriate — ICIs bill chemo admin per AMA
`JZ`	Required: 1,500 mg flat = 3 × 500 mg vials, zero waste
`JW`	10 mg/kg weight-based: any partial-vial waste line-itemed

ICD-10 by indication

Code	For
`C34.x`	NSCLC (lobe-specific 4th char) & SCLC histology
`C22.0`	HCC (hepatocellular)
`C22.1, C23, C24.x`	Biliary tract / gallbladder / intrahepatic + extrahepatic
`C54.x`	Endometrial
`C67.x`	Urothelial / bladder

Checkpoint class — at a glance

Drug	HCPCS	Target
Imfinzi	`J9173`	PD-L1
Tecentriq	`J9022`	PD-L1
Keytruda	`J9271`	PD-1
Opdivo	`J9299`	PD-1
Libtayo	`J9119`	PD-1
Jemperli	`J9272`	PD-1
Yervoy	`J9228`	CTLA-4
Imjudo	`J9347`	CTLA-4 (AZ combo)

Payer requirements (May 2026)

Payer	PA	Step / Notes
UnitedHealthcare	Yes	Indication-specific docs (PACIFIC = stage III NSCLC + recent CRT; ADRIATIC = LS-SCLC + recent CRT)
Aetna	Yes	Step from chemo for some indications; CPB ICI policy
Carelon / Anthem	Yes	Oncology medical drug policy
Medicare	LCD	All MAC LCDs cover all FDA-approved indications

Medicare reimbursement (Q2 2026)

Field	Value
ASP + 6%	$86.146 / 10 mg unit (4/1 – 6/30/2026)
1,500 mg dose (q4w)	$12,921.90 (150 units)
Annual q4w (13 doses)	~$167,985
Annual mixed q3w→q4w	~$180,000–195,000 (combo year)

Patient assistance — AZ Access 360

Phone: 1-844-275-2360 (AstraZeneca Access 360)
Imfinzi Co-pay Program: commercial $0 first dose; up to $25,000/yr ongoing
AZ Patient Assistance Foundation (PAF): free drug for uninsured/underinsured
Web: azandmeapp.com / myaccess360.com

irAE WARNINGS (treat as Boxed analog): immune-mediated pneumonitis, colitis, hepatitis, endocrinopathies (hypothyroidism most common, also T1DM, adrenal insufficiency, hypophysitis), nephritis, dermatologic, infusion reactions. Higher pneumonitis rate when combined with chemoradiation in PACIFIC regimen — surveillance imaging + steroid algorithm critical.

Sources: FDA label (most recent rev incl. ADRIATIC LS-SCLC 2024 + AEGEAN resectable NSCLC 2024), CMS ASP Q2 2026, NCCN (NSCLC/SCLC/HCC/Biliary/Endometrial/Bladder), AstraZeneca Access 360, UHC/Aetna oncology policies. carecostestimate.com/drugs/imfinzi