J9268 HCPCS code: Injection, pentostatin, 10 mg
J9268 is the HCPCS Level II code for injection, pentostatin, 10 mg. In 2024 Medicare paid an average of $1,902.68 per service for J9268 across 45 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 1 per day on outpatient hospital claims. Medicare volume fell 4% from 2022 to 2024 (47 to 45 services). In 2024, about 23 clinicians billed Medicare for J9268 for 13 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 | O1D — Chemotherapy |
| Added | 1994-01-01 |
| Last action effective | 2009-01-01 |
Who bills J9268 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 23 |
| Medicare beneficiaries | 13 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9268, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 47 | 13 | $2,071.08 | $1,645.27 |
| 2023 | 88 | 12 | $2,197.51 | $1,781.71 |
| 2024 | 45 | 13 | $2,366.47 | $1,902.68 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 1 | Prescribing Information |
| practitioner claims | 1 | Prescribing Information |
What changed for J9268
- 1994-01-01: J9268 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 J9268?
J9268 is the HCPCS Level II code for injection, pentostatin, 10 mg. Short descriptor: "Pentostatin injection".
How much does Medicare pay for J9268?
In 2024, the average Medicare payment was $1,902.68 per service (average allowed $2,366.47).
Does Medicare cover J9268?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
How many units of J9268 can be billed per day?
1 on outpatient hospital claims; 1 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 J9268
- Watch J9268 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9268
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.