J9999 HCPCS code: Not otherwise classified, antineoplastic drugs
J9999 is the HCPCS Level II code for not otherwise classified, antineoplastic drugs. In 2024 Medicare paid an average of $512.76 per service for J9999 across 14,551 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. Medicare volume fell 35% from 2022 to 2024 (22,551 to 14,551 services). In 2024, about 423 clinicians billed Medicare for J9999 for 1,296 beneficiaries; Florida, California, Ohio accounted for 73% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 1986-01-01 |
| Last action effective | 1997-01-01 |
Who bills J9999 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 423 |
| Medicare beneficiaries | 1,296 |
| States with claims | 13 |
| Share of services in top 3 states (Florida, California, Ohio) | 73% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9999, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 22,551 | 492 | $822.00 | $655.68 |
| 2023 | 26,859 | 1,421 | $781.27 | $622.47 |
| 2024 | 14,551 | 1,296 | $643.70 | $512.76 |
States with the most J9999 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 4,469 | $125.17 |
| California | 2,370 | $214.58 |
| Ohio | 1,665 | $184.29 |
| Illinois | 1,401 | $352.61 |
| Nevada | 792 | $195.12 |
Medicare policy articles for this code
- A52507: External Infusion Pumps - Policy Article (CGS Administrators, LLC (DME MAC) Noridian Healthcare Solutions, LLC (DME MAC)) — mentions this code in its coding guidance
- A54880: Billing and Coding: Additional Claim Documentation Requirements for Not Otherwise Classified (NOC) Drugs and Biological Products with Specific FDA Label Indications (Palmetto GBA (MAC - Part A, MAC - Part B))
Covered diagnoses (460 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| C91.00 | Acute lymphoblastic leukemia not having achieved remission | 1 |
| C91.01 | Acute lymphoblastic leukemia, in remission | 1 |
| C91.02 | Acute lymphoblastic leukemia, in relapse | 1 |
| D80.0 | Hereditary hypogammaglobulinemia | 1 |
| D80.2 | Selective deficiency of immunoglobulin A [IgA] | 1 |
| D80.3 | Selective deficiency of immunoglobulin G [IgG] subclasses | 1 |
| D80.4 | Selective deficiency of immunoglobulin M [IgM] | 1 |
| D80.5 | Immunodeficiency with increased immunoglobulin M [IgM] | 1 |
| D80.6 | Antibody deficiency with near-normal immunoglobulins or with hyperimmunoglobulinemia | 1 |
| D80.7 | Transient hypogammaglobulinemia of infancy | 1 |
Showing 10 of 460. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J9999
- 1986-01-01: J9999 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 J9999?
J9999 is the HCPCS Level II code for not otherwise classified, antineoplastic drugs. Short descriptor: "Chemotherapy drug".
How much does Medicare pay for J9999?
In 2024, the average Medicare payment was $512.76 per service (average allowed $643.70).
Does Medicare cover J9999?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J9999?
Medicare policy articles that cite J9999 list 460 covered ICD-10-CM diagnosis codes across 2 articles. The most cited include C91.00 (Acute lymphoblastic leukemia not having achieved remission), C91.01 (Acute lymphoblastic leukemia, in remission), C91.02 (Acute lymphoblastic leukemia, in relapse). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
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 J9999
- Watch J9999 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9999
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.