J9260 HCPCS code: Injection, methotrexate sodium, 50 mg
J9260 is the HCPCS Level II code for injection, methotrexate sodium, 50 mg. In 2024 Medicare paid an average of $1.83 per service for J9260 across 44,165 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 400 per day on DME suppliers. Medicare volume rose 84% from 2022 to 2024 (23,966 to 44,165 services). In 2024, about 1,448 clinicians billed Medicare for J9260 for 4,477 beneficiaries; Florida, New Jersey, New York accounted for 47% of services.
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 | O1D — Chemotherapy |
| Added | 1984-01-01 |
| Last action effective | 2024-04-01 |
Who bills J9260 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,448 |
| Medicare beneficiaries | 4,477 |
| States with claims | 38 |
| Share of services in top 3 states (Florida, New Jersey, New York) | 47% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9260, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 23,966 | 3,098 | $2.16 | $1.66 |
| 2023 | 20,879 | 2,961 | $2.30 | $1.77 |
| 2024 | 44,165 | 4,477 | $2.35 | $1.83 |
States with the most J9260 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 8,382 | $1.82 |
| New Jersey | 6,569 | $1.83 |
| New York | 5,595 | $1.60 |
| Massachusetts | 4,012 | $1.51 |
| California | 3,918 | $1.98 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 400 | Prescribing Information |
| outpatient hospital claims | 400 | Prescribing Information |
| practitioner claims | 400 | Prescribing Information |
Medicare policy articles for this code
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
Covered diagnoses (564 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| A63.0 | Anogenital (venereal) warts | 1 |
| B07.0 | Plantar wart | 1 |
| B07.8 | Other viral warts | 1 |
| B07.9 | Viral wart, unspecified | 1 |
| B27.00 | Gammaherpesviral mononucleosis without complication | 1 |
| B27.01 | Gammaherpesviral mononucleosis with polyneuropathy | 1 |
| B27.02 | Gammaherpesviral mononucleosis with meningitis | 1 |
| B27.09 | Gammaherpesviral mononucleosis with other complications | 1 |
| D47.3 | Essential (hemorrhagic) thrombocythemia | 1 |
| D47.Z1 | Post-transplant lymphoproliferative disorder (PTLD) | 1 |
Showing 10 of 564. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J9260
- 1984-01-01: J9260 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 J9260?
J9260 is the HCPCS Level II code for injection, methotrexate sodium, 50 mg. Short descriptor: "Inj methotrexate sodium 50mg".
How much does Medicare pay for J9260?
In 2024, the average Medicare payment was $1.83 per service (average allowed $2.35).
Does Medicare cover J9260?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J9260?
Medicare policy articles that cite J9260 list 564 covered ICD-10-CM diagnosis codes across 1 article. The most cited include A63.0 (Anogenital (venereal) warts), B07.0 (Plantar wart), B07.8 (Other viral warts). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J9260 can be billed per day?
400 on DME suppliers; 400 on outpatient hospital claims; 400 on practitioner claims (NCCI medically unlikely edits).
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
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Next steps
- Run a reimbursement report for a device billed under J9260
- Watch J9260 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9260
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.