J9264 HCPCS code: Injection, paclitaxel protein-bound particles, 1 mg
J9264 is the HCPCS Level II code for injection, paclitaxel protein-bound particles, 1 mg. In 2024 Medicare paid an average of $10.62 per service for J9264 across 7,866,261 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 800 per day on DME suppliers. Medicare volume fell 16% from 2022 to 2024 (9,409,425 to 7,866,261 services). In 2024, about 3,243 clinicians billed Medicare for J9264 for 5,054 beneficiaries; Florida, California, Texas accounted for 35% 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 | O1E — Other drugs |
| Added | 2006-01-01 |
| Last action effective | 2007-01-01 |
Who bills J9264 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,243 |
| Medicare beneficiaries | 5,054 |
| States with claims | 42 |
| Share of services in top 3 states (Florida, California, Texas) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9264, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 9,409,425 | 5,895 | $13.50 | $10.77 |
| 2023 | 8,740,919 | 5,416 | $12.22 | $9.74 |
| 2024 | 7,866,261 | 5,054 | $13.33 | $10.62 |
States with the most J9264 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 998,249 | $10.69 |
| California | 994,494 | $10.67 |
| Texas | 716,066 | $10.62 |
| Illinois | 418,194 | $10.69 |
| New York | 365,495 | $10.63 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 800 | Prescribing Information |
| outpatient hospital claims | 800 | Prescribing Information |
| practitioner claims | 800 | Prescribing Information |
Medicare policy articles for this code
- A52450: Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™) (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (699 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C00.0 | Malignant neoplasm of external upper lip | 1 |
| C00.1 | Malignant neoplasm of external lower lip | 1 |
| C00.2 | Malignant neoplasm of external lip, unspecified | 1 |
| C00.3 | Malignant neoplasm of upper lip, inner aspect | 1 |
| C00.4 | Malignant neoplasm of lower lip, inner aspect | 1 |
| C00.5 | Malignant neoplasm of lip, unspecified, inner aspect | 1 |
| C00.6 | Malignant neoplasm of commissure of lip, unspecified | 1 |
| C00.8 | Malignant neoplasm of overlapping sites of lip | 1 |
| C00.9 | Malignant neoplasm of lip, unspecified | 1 |
| C01 | Malignant neoplasm of base of tongue | 1 |
Showing 10 of 699. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J9264
- 2006-01-01: J9264 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 J9264?
J9264 is the HCPCS Level II code for injection, paclitaxel protein-bound particles, 1 mg. Short descriptor: "Paclitaxel protein bound".
How much does Medicare pay for J9264?
In 2024, the average Medicare payment was $10.62 per service (average allowed $13.33).
Does Medicare cover J9264?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
Which diagnoses support coverage for J9264?
Medicare policy articles that cite J9264 list 699 covered ICD-10-CM diagnosis codes across 1 article. The most cited include C00.0 (Malignant neoplasm of external upper lip), C00.1 (Malignant neoplasm of external lower lip), C00.2 (Malignant neoplasm of external lip, unspecified). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J9264 can be billed per day?
800 on DME suppliers; 800 on outpatient hospital claims; 800 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 J9264
- Watch J9264 for fee, coverage and descriptor changes
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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.