J9042 HCPCS code: Injection, brentuximab vedotin, 1 mg
J9042 is the HCPCS Level II code for injection, brentuximab vedotin, 1 mg. In 2024 Medicare paid an average of $185.43 per service for J9042 across 259,495 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 200 per day on outpatient hospital claims. Medicare volume fell 23% from 2022 to 2024 (335,623 to 259,495 services). In 2024, about 692 clinicians billed Medicare for J9042 for 435 beneficiaries; Florida, Texas, California accounted for 52% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2013-01-01 |
| Last action effective | 2013-01-01 |
Who bills J9042 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 692 |
| Medicare beneficiaries | 435 |
| States with claims | 12 |
| Share of services in top 3 states (Florida, Texas, California) | 52% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9042, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 335,623 | 548 | $197.58 | $157.80 |
| 2023 | 312,999 | 539 | $213.23 | $170.29 |
| 2024 | 259,495 | 435 | $229.84 | $185.43 |
States with the most J9042 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 40,100 | $186.30 |
| Texas | 29,897 | $185.81 |
| California | 19,468 | $184.98 |
| Arizona | 15,700 | $185.21 |
| Illinois | 11,550 | $186.87 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 200 | CMS Policy |
| practitioner claims | 200 | CMS Policy |
What changed for J9042
- 2013-01-01: J9042 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J9042?
J9042 is the HCPCS Level II code for injection, brentuximab vedotin, 1 mg. Short descriptor: "Brentuximab vedotin inj".
How much does Medicare pay for J9042?
In 2024, the average Medicare payment was $185.43 per service (average allowed $229.84).
Does Medicare cover J9042?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9042 can be billed per day?
200 on outpatient hospital claims; 200 on practitioner claims (NCCI medically unlikely edits).
Related J90 codes
- J9000 — Injection, doxorubicin hydrochloride, 10 mg
- J9003 — Leuprolide injectable (camcevi etm), 1 mg
- J9010 — Injection, alemtuzumab, 10 mg
- J9011 — Injection, datopotamab deruxtecan-dlnk, 1 mg
- J9015 — Injection, aldesleukin, per single use vial
- J9017 — Injection, arsenic trioxide, 1 mg
- J9019 — Injection, asparaginase (erwinaze), 1,000 iu
- J9020 — Injection, asparaginase, not otherwise specified, 10,000 units
- J9021 — Injection, asparaginase, recombinant, (rylaze), 0.1 mg
- J9022 — Injection, atezolizumab, 10 mg
- J9023 — Injection, avelumab, 10 mg
- J9024 — Injection, atezolizumab, 5 mg and hyaluronidase-tqjs
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Next steps
- Run a reimbursement report for a device billed under J9042
- Watch J9042 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9042
Sources: CMS HCPCS Level II release October 2026; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.