J9304 HCPCS code: Injection, pemetrexed (pemfexy), 10 mg
J9304 is the HCPCS Level II code for injection, pemetrexed (pemfexy), 10 mg. In 2024 Medicare paid an average of $44.69 per service for J9304 across 796,997 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 595% from 2022 to 2024 (114,708 to 796,997 services). In 2024, about 1,263 clinicians billed Medicare for J9304 for 2,270 beneficiaries; Florida, California, Illinois accounted for 36% 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 | O1E — Other drugs |
| Added | 2020-10-01 |
| Last action effective | 2020-10-01 |
Who bills J9304 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,263 |
| Medicare beneficiaries | 2,270 |
| States with claims | 34 |
| Share of services in top 3 states (Florida, California, Illinois) | 36% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9304, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 114,708 | 435 | $76.57 | $61.06 |
| 2023 | 585,274 | 1,832 | $68.33 | $54.44 |
| 2024 | 796,997 | 2,270 | $56.09 | $44.69 |
States with the most J9304 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 157,228 | $45.25 |
| California | 83,543 | $44.80 |
| Illinois | 45,641 | $44.37 |
| Alabama | 34,648 | $44.23 |
| Virginia | 32,633 | $44.55 |
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 J9304
- 2020-10-01: J9304 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 J9304?
J9304 is the HCPCS Level II code for injection, pemetrexed (pemfexy), 10 mg. Short descriptor: "Inj. pemetrexed, 10 mg".
How much does Medicare pay for J9304?
In 2024, the average Medicare payment was $44.69 per service (average allowed $56.09).
Does Medicare cover J9304?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9304 can be billed per day?
150 on outpatient hospital claims; 150 on practitioner claims (NCCI medically unlikely edits).
Related J93 codes
- J9300 — Injection, gemtuzumab ozogamicin, 5 mg
- J9301 — Injection, obinutuzumab, 10 mg
- J9302 — Injection, ofatumumab, 10 mg
- J9303 — Injection, panitumumab, 10 mg
- J9305 — Injection, pemetrexed, not otherwise specified, 10 mg
- J9306 — Injection, pertuzumab, 1 mg
- J9307 — Injection, pralatrexate, 1 mg
- J9308 — Injection, ramucirumab, 5 mg
- J9309 — Injection, polatuzumab vedotin-piiq, 1 mg
- J9310 — Injection, rituximab, 100 mg
- J9311 — Injection, rituximab 10 mg and hyaluronidase
- J9312 — Injection, rituximab, 10 mg
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Next steps
- Run a reimbursement report for a device billed under J9304
- Watch J9304 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9304
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.