J9274 HCPCS code: Injection, tebentafusp-tebn, 1 microgram
J9274 is the HCPCS Level II code for injection, tebentafusp-tebn, 1 microgram. In 2024 Medicare paid an average of $165.15 per service for J9274 across 118,850 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 100 per day on outpatient hospital claims. Medicare volume rose 569% from 2022 to 2024 (17,767 to 118,850 services). In 2024, about 204 clinicians billed Medicare for J9274 for 59 beneficiaries.
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 | 2022-10-01 |
| Last action effective | 2022-10-01 |
Who bills J9274 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 204 |
| Medicare beneficiaries | 59 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9274, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 17,767 | 21 | $191.26 | $152.39 |
| 2023 | 100,188 | 51 | $198.26 | $157.95 |
| 2024 | 118,850 | 59 | $207.14 | $165.15 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 100 | CMS Policy |
| practitioner claims | 100 | CMS Policy |
What changed for J9274
- 2022-10-01: J9274 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 J9274?
J9274 is the HCPCS Level II code for injection, tebentafusp-tebn, 1 microgram. Short descriptor: "Inj, tebentafusp-tebn, 1 mcg".
How much does Medicare pay for J9274?
In 2024, the average Medicare payment was $165.15 per service (average allowed $207.14).
Does Medicare cover J9274?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9274 can be billed per day?
100 on outpatient hospital claims; 100 on practitioner claims (NCCI medically unlikely edits).
Related J92 codes
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- 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 J9274
- Watch J9274 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9274
Sources: CMS HCPCS Level II release October 2026; 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.