J9294 HCPCS code: Injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg
J9294 is the HCPCS Level II code for injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg. In 2024 Medicare paid an average of $4.17 per service for J9294 across 3,140 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 150 per day on outpatient hospital claims. In 2024, about 9 clinicians billed Medicare for J9294 for 11 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 | O1E — Other drugs |
| Added | 2023-04-01 |
| Last action effective | 2024-07-01 |
Who bills J9294 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 9 |
| Medicare beneficiaries | 11 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9294, 2024–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2024 | 3,140 | 11 | $5.28 | $4.17 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
What changed for J9294
- 2023-04-01: J9294 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 J9294?
J9294 is the HCPCS Level II code for injection, pemetrexed (hospira), not therapeutically equivalent to j9305, 10 mg. Short descriptor: "Inj pemetrexed, hospira 10mg".
How much does Medicare pay for J9294?
In 2024, the average Medicare payment was $4.17 per service (average allowed $5.28).
Does Medicare cover J9294?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9294 can be billed per day?
150 on outpatient hospital claims; 150 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 J9294
- Watch J9294 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9294
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.