J9255 HCPCS code: Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg
J9255 is the HCPCS Level II code for injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg. In 2024 Medicare paid an average of $5.65 per service for J9255 across 543 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. In 2024, about 18 clinicians billed Medicare for J9255 for 46 beneficiaries.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1E — Other drugs |
| Added | 2024-01-01 |
| Last action effective | 2024-04-01 |
Who bills J9255 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 18 |
| Medicare beneficiaries | 46 |
| States with claims | 1 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9255, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 543 | 46 | $7.09 | $5.65 |
States with the most J9255 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 241 | $2.05 |
What changed for J9255
- 2024-01-01: J9255 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 J9255?
J9255 is the HCPCS Level II code for injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg. Short descriptor: "Inj, methotrexate (accord)".
How much does Medicare pay for J9255?
In 2024, the average Medicare payment was $5.65 per service (average allowed $7.09).
Does Medicare cover J9255?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Related J92 codes
- J9200 — Injection, floxuridine, 500 mg
- J9201 — Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg
- J9202 — Goserelin acetate implant, per 3.6 mg
- 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
- J9208 — Injection, ifosfamide, 1 gram
- J9209 — Injection, mesna, 200 mg
- J9210 — Injection, emapalumab-lzsg, 1 mg
- J9211 — Injection, idarubicin hydrochloride, 5 mg
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J9255
- Watch J9255 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9255
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.