J9249 HCPCS code: Injection, melphalan (apotex), 1 mg
J9249 is the HCPCS Level II code for injection, melphalan (apotex), 1 mg. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 48 per day on DME suppliers.
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 | 2024-04-01 |
| Last action effective | 2025-07-01 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 48 | Prescribing Information |
| outpatient hospital claims | 48 | Prescribing Information |
| practitioner claims | 48 | Prescribing Information |
What changed for J9249
- 2024-04-01: J9249 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 J9249?
J9249 is the HCPCS Level II code for injection, melphalan (apotex), 1 mg. Short descriptor: "Inj, melphalan (apotex) 1 mg".
Does Medicare cover J9249?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9249 can be billed per day?
48 on DME suppliers; 48 on outpatient hospital claims; 48 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
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- J9201 — Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
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- J9203 — Injection, gemtuzumab ozogamicin, 0.1 mg
- J9204 — Injection, mogamulizumab-kpkc, 1 mg
- J9205 — Injection, irinotecan liposome, 1 mg
- J9206 — Injection, irinotecan, 20 mg
- J9207 — Injection, ixabepilone, 1 mg
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- J9210 — Injection, emapalumab-lzsg, 1 mg
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Next steps
- Run a reimbursement report for a device billed under J9249
- Watch J9249 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9249
Sources: CMS HCPCS Level II release October 2025; 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.