Kyprolis (carfilzomib) — HCPCS J9047
CareCost Estimate · Billing Cheat Sheet
Amgen
10 / 30 / 60 mg lyophilized single-dose vials
IV infusion 10–30 min
Reviewed: May 2, 2026
ASP: Q2 2026
Dose (Kd)
56 mg/m²
IV weekly · BSA-based
Modifier
JW
Waste typical (10/30/60 mg vials)
Admin CPT
96413
Chemo IV + 96361 hydration
ASP+6%
$56.239
/mg · ~$6,074 / 108 mg
CARDIAC TOXICITY W&P (boxed-analog): cardiac arrest, MI, new/worsening HF, ischemia, hypertensive crisis. Rates exceed Velcade. Baseline cardiac assessment + ongoing BP monitoring at every visit. Active cardiac disease, recent MI, or uncontrolled HTN typically excludes patient. Major reason payers steer cardiac-comorbid patients to Velcade.
Cycle 1 step-up dosing required (all regimens): 20 mg/m² on D1 + D2 of cycle 1, then escalate to target dose on D8 onward. Bill at the actual mg administered (loading dose). Reinstate cycle 1 monitoring intensity on any future dose escalation (e.g., Kd 56 → 70 mg/m²).
Pre + post-hydration during cycle 1: 250–500 mL IV NS BEFORE and AFTER each dose. Adds 60+ minutes of chair time. Bill 96361 (hydration sequential to chemo). Reducible cycle 2 onward if tolerated.
Codes & NDC
| HCPCS | J9047 — "Inj, carfilzomib, 1 mg" (Amgen) |
|---|
| NDC (10 mg) | 76310-005-01 / 76310-0005-01 — N4 qualifier |
|---|
| NDC (30 mg) | 76310-006-01 / 76310-0006-01 |
|---|
| NDC (60 mg) | 76310-007-01 / 76310-0007-01 |
|---|
| Reconstitution | Sterile water for injection → 2 mg/mL all vials |
|---|
| Benefit | Medical (provider buy-and-bill) |
|---|
Proteasome inhibitor class
| Drug | HCPCS | Class |
|---|
| Kyprolis (carfilzomib) | J9047 | 2nd-gen irreversible |
| Velcade (bortezomib) | J9041 (0.1 mg) | 1st-gen reversible |
| Bortezomib generic | J9049 (0.1 mg) | 1st-gen, ~44% cheaper |
| Boruzu (premixed) | J9054 (0.1 mg) | 1st-gen, no reconstitution |
| Ninlaro (ixazomib) | Pharmacy | 1st-gen oral, no J-code |
Kyprolis vs Velcade trade-off: greater efficacy + better neuropathy profile, BUT higher cardiac AE rates. Switching = regimen change requiring fresh PA.
Regimens (R/R MM)
| Regimen | Dose | Schedule |
|---|
| Kd (+dex) | 56 or 70 mg/m² | D1, 8, 15 weekly per 28-d cycle |
| KRd (+lenalidomide+dex) | 27 mg/m² | D1, 2, 8, 9, 15, 16 (twice/wk × 3 wk) |
| Kdara (+daratumumab+dex) | 56 or 70 mg/m² | D1, 8, 15 weekly per 28-d cycle |
| Kpd (+pomalidomide+dex) | 27 mg/m² | D1, 2, 8, 9, 15, 16 (twice/wk × 3 wk) |
C1 step-up: 20 mg/m² D1 + D2 of cycle 1 (all regimens), target dose D8 onward.
Administration & modifiers
| Code | When |
|---|
96413 | Primary — chemo IV, ≤1 hr (10–30 min infusion) |
96415 | Chemo IV, each addl hour (combo days, extended hydration) |
96361 | IV hydration sequential (pre/post during cycle 1) |
96365 | NOT appropriate — Kyprolis is anti-neoplastic chemo |
96372 | NOT appropriate — no SC formulation; IV only |
JW typical: 10/30/60 mg vials vs BSA-calc dose → partial-vial waste. Bill JW line for discarded units. JZ only when whole-vial multiples (rare). One of JZ/JW required per CMS 7/1/2023.
BSA → units (Kd 56 mg/m²)
| BSA | Dose | Units | Vials | JW |
|---|
| 1.5 m² | 84 mg | 84 | 60+30 | 6 |
| 1.7 m² | 95.2 mg | 95 | 60+30+30 | 25 |
| 1.92 m² (avg) | 107.5 mg | 108 | 60+30+30 | 12 |
| 2.0 m² | 112 mg | 112 | 60+30+30 | 8 |
| 2.2 m² | 123.2 mg | 123 | 60+60+30 | 27 |
ICD-10 — Multiple Myeloma
| Code | For |
|---|
C90.00 | MM not having achieved remission |
C90.01 | MM in remission |
C90.02 | MM in relapse (most common; R/R indication) |
C90.1x | Plasma cell leukemia (off-label, PA) |
C90.3x | Solitary plasmacytoma (off-label, PA) |
Regimen acronym + line of therapy required. PA must include Kd / KRd / Kdara / Kpd, prior regimens, response/failure, target dose, cardiac status. ICD-10 alone insufficient.
Cardiac assessment (PA req'd)
- Baseline ECG (standard MM workup)
- Echocardiogram if symptomatic / cardiac history; LVEF documented
- Baseline BP + control regimen documented
- Cardiology consult if >65 + cardiac comorbidity / HF / recent MI
- Ongoing BP at every visit during cycle 1
- Uncontrolled HTN = most common mid-treatment review trigger
Payer requirements (May 2026)
| Payer | PA | Key requirement |
|---|
| UnitedHealthcare | Yes | ≥1 prior MM tx (combo) / ≥2 (mono); cardiac docs |
| Aetna | Yes | R/R MM + cardiac baseline; HF/recent MI excludes |
| BCBS plans | Yes | NCCN-aligned; cardiac assessment |
| Medicare Advantage | Plan-dep. | Often follows commercial logic |
Combo PA chains: lenalidomide REMS for KRd, pomalidomide REMS for Kpd, daratumumab PA for Kdara. All combo agents must clear in parallel before regimen starts.
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| J9047 ASP+6% | $56.239 / mg |
| 108 mg dose (Kd 56 @ 1.92 m²) | $6,073.81 |
| 52 mg dose (KRd 27 @ 1.92 m²) | $2,924.43 |
| Annualized Kd weekly | ~$237,000/yr drug-only |
| After ~2% sequestration | ~$232,000/yr actual paid |
Site of care
| Setting | POS | Notes |
|---|
| Hospital outpatient | 22 | Common cycle 1 + escalation (cardiac monitoring) |
| Physician oncology office | 11 | Acceptable post-cycle 1 if cardiac stable |
| Ambulatory infusion suite | 49 | Acceptable post-cycle 1 |
| Oncology ASC | 24 | Acceptable |
| Patient home | 12 | NOT appropriate — cardiac monitoring |
Patient assistance — Amgen Assist 360
- Phone: 1-888-427-7478 (Amgen Assist 360)
- Kyprolis Co-Pay Card: commercial $5 first dose, ongoing copay support up to $25,000/year
- Amgen Safety Net Foundation: free product for uninsured / underinsured
- Medicare foundations: PAN, HealthWell, CancerCare, LLS Co-Pay — verify open MM funds quarterly
- Web: amgenassist360.com / kyprolis.com
Other key W&P: thrombotic microangiopathy / TTP, pulmonary toxicity (pneumonitis, ARDS, pulmonary edema), pulmonary hypertension, infusion reactions, tumor lysis syndrome, hepatic events, renal toxicity, embryo-fetal toxicity, VTE (esp. with lenalidomide).