J9297 HCPCS code: Injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg
J9297 is the HCPCS Level II code for injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg. In 2024 Medicare paid an average of $1.00 per service for J9297 across 6,557 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. Medicare volume rose 12% from 2023 to 2024 (5,867 to 6,557 services). In 2024, about 43 clinicians billed Medicare for J9297 for 28 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 | 2023-04-01 |
Who bills J9297 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 43 |
| Medicare beneficiaries | 28 |
| States with claims | 0 |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9297, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 5,867 | 27 | $3.61 | $2.86 |
| 2024 | 6,557 | 28 | $1.26 | $1.00 |
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 J9297
- 2023-04-01: J9297 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 J9297?
J9297 is the HCPCS Level II code for injection, pemetrexed (sandoz), not therapeutically equivalent to j9305, 10 mg. Short descriptor: "Inj pemetrexed (sandoz) 10mg".
How much does Medicare pay for J9297?
In 2024, the average Medicare payment was $1.00 per service (average allowed $1.26).
Does Medicare cover J9297?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9297 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
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 J9297
- Watch J9297 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9297
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.