J9271 HCPCS code: Injection, pembrolizumab, 1 mg
J9271 is the HCPCS Level II code for injection, pembrolizumab, 1 mg. In 2024 Medicare paid an average of $44.04 per service for J9271 across 38,018,750 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 400 per day on outpatient hospital claims. Medicare volume rose 7% from 2022 to 2024 (35,596,797 to 38,018,750 services). In 2024, about 5,121 clinicians billed Medicare for J9271 for 27,542 beneficiaries; Florida, Texas, California accounted for 34% 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 | O1D — Chemotherapy |
| Added | 2016-01-01 |
| Last action effective | 2016-01-01 |
Who bills J9271 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 5,121 |
| Medicare beneficiaries | 27,542 |
| States with claims | 53 |
| Share of services in top 3 states (Florida, Texas, California) | 34% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9271, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 35,596,797 | 25,731 | $52.05 | $41.55 |
| 2023 | 37,378,639 | 26,763 | $53.44 | $42.57 |
| 2024 | 38,018,750 | 27,542 | $55.28 | $44.04 |
States with the most J9271 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 4,871,506 | $43.77 |
| Texas | 4,004,060 | $44.36 |
| California | 3,970,300 | $43.67 |
| Illinois | 2,020,853 | $44.14 |
| Virginia | 1,684,510 | $44.28 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 400 | Prescribing Information |
| practitioner claims | 400 | Prescribing Information |
What changed for J9271
- 2016-01-01: J9271 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 J9271?
J9271 is the HCPCS Level II code for injection, pembrolizumab, 1 mg. Short descriptor: "Inj pembrolizumab".
How much does Medicare pay for J9271?
In 2024, the average Medicare payment was $44.04 per service (average allowed $55.28).
Does Medicare cover J9271?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9271 can be billed per day?
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 J9271
- Watch J9271 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9271
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.