J9259 NDC Crosswalk, Billing Units, ASP Payment & Medicare Reimbursement

📋 J9259 summary

J9259 is a HCPCS Level II J-code used to bill paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j92.... The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.

Brand names associated with J9259: Paclitaxel Protein Bound Particles Albumin Bound

Code J9259 NDC-Crosswalk 1 RxCUI Atlas Trace the drug concept →

⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.

🗂️ Key billing facts

HCPCS codeJ9259

DescriptorInjection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 1 mg

Billing unitNot available in current dataset

Payment limit / unit Not available in current dataset

Mapped NDCs1

Data periodNot available in current dataset

Last updatedSource date not available

🧾 Billing & reimbursement HCPCS · CMS

Medicare payment limit / unit

—

Est. ASP / unit

—

Est. after 2% sequester

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HCPCS dosage

—

The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly).

Full HCPCS code details (official CMS record)

Long descriptionInjection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 1 mg

CoverageC — Carrier/MAC judgment

Pricing indicator51 — Drug — priced under the ASP methodology

Type of service1 — Medical care

BETOS-2O1E

ASC payment groupYY

Action codeN — No maintenance this year

Effective date2023-07-01

Date added2023-07-01

Source: CMS HCPCS Level II code file (imported via admin).

🧮 Dosing & billing-units calculator HCPCS UNITS

One billing unit of J9259 = 1 unit. Enter a regimen to convert dose → billing units and project a full course.

Dose per administration (unit) Frequency — every days Number of doses NDC / package billed (optional)

Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.

🔁 NDCs that bill under J9259 CROSSWALKED NDCs

1 NDC map to J9259. Bill units = how many HCPCS units one package represents.

NDC (11-digit)	Drug	Labeler	Package	Strength	Bill units	NADAC / unit	Status	Source
00517-4300-01	PACLITAXEL PROTEIN BOUND PARTICLES ALBUMIN 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION	American	1 VIAL in 1 CARTON (0517-4300-01) / 20 mL...	100 mg/20mL	100	—	● Active	PDAC

NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.

⚠️ Don't confuse J9259 with… RELATED CODES

Adjacent HCPCS codes that share an ingredient or formulation with J9259. Billing units and payment limits differ — confirm the exact code, strength and form before billing.

Code	Descriptor	Billing unit	Payment limit / unit	How it differs from J9259
J9264	Paclitaxel protein bound	1 MG	$6.586	Related ingredient or formulation — confirm strength, form and billing unit before substituting.
J9267	Paclitaxel injection	1 MG	$0.112	Related ingredient or formulation — confirm strength, form and billing unit before substituting.

Related codes matched on shared ingredient (CMS Medicare Part B Spending feed). Billing units and payment limits from the CMS ASP Pricing File. Always verify the precise HCPCS code for the product and strength administered.

🗺️ Where J9259 is utilized CMS · BY PROVIDER · 2024

Medicare Part B services for this code by the rendering provider's state — 16,706 services across 1 states & territories in 2024 (CMS reports include DC and U.S. territories). Switch to per 100k to compare states fairly regardless of population. Hover or tap a state for its top ZIP codes.

Hover or tap a state to see its numbers + top ZIP codes.

Per-capita = services ÷ 2023 state population × 100,000 (so high-population states aren't automatically "hotter"). Counts reflect the provider's location, not the patient's. Providers with fewer than 11 patients are hidden by CMS for privacy, so totals run low and per-100k can be noisy in small states — read this as relative geography, not exact counts. Source: CMS Medicare Physician & Other Practitioners — by Provider and Service, 2024.

📊 What bills under J9259

J-codes are billing codes often used for drugs billed under the medical benefit. This connects the billing code to the NDC package records it covers, by ingredient and labeler.

NDC products by ingredient

Paclitaxel 1

NDC products by labeler

American Regent, Inc. 1

🔗 Related NDC directory pages

🧪 All Paclitaxel NDCsIngredient 🏭 All American labeler NDCsLabeler 00517 📚 All Microtubule Inhibitor NDCsDrug class

🗃️ Data sources & freshness

Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.

HCPCS code & descriptor

CMS HCPCS Level II code file

Loaded

Payment limit & billing unit

CMS Medicare Part B ASP Pricing File (quarterly)

Not available

NDC ↔ HCPCS crosswalk

CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)

1 NDC mapped

NADAC acquisition cost

CMS National Average Drug Acquisition Cost (weekly)

Not available for mapped NDCs

Utilization & spend

CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners

No reportable utilization

Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.

⚠️ Practical billing caveats

A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.

❓ J9259 billing FAQ

What is HCPCS code J9259?

J9259 is a HCPCS Level II J-code used to bill Injection, paclitaxel protein-bound particles (american regent) not therapeutically equivalent to j9264, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.

Which NDCs bill under J9259?

1 NDC currently map to J9259 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.

Does a crosswalk mean J9259 is covered?

No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.

J9259 – Injection, paclitaxel protein-bound particles (american regent) not ther · NDC Crosswalk & Billing Units