J9264
J9264 – Injection, paclitaxel protein-bound particles, 1 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 11 NDCs crosswalked per 1 MG $6.586/unit ASP+6%
📋 J9264 summary
J9264 is a HCPCS Level II J-code used to bill paclitaxel protein-bound particles, 1 mg, billed per 1 MG. 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 J9264: Abraxane*, Paclitaxel, Paclitaxel Protein Bound Particles Albumin Bound
Code J9264
Billing unit 1 MG Payment limit $6.586/unit NDC-Crosswalk 11
Quarter Q3 2026
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 codeJ9264
DescriptorInjection, paclitaxel protein-bound particles, 1 mg
Billing unit1 MG
Payment limit / unit$6.586
Est. ASP / unit$6.213 est.
Mapped NDCs11
Data periodQ3 2026
Last updated2026-08-20
💊 About Paclitaxel DRUG GUIDE
Paclitaxel injection (solution form) is used for advanced ovarian cancer, node-positive breast cancer (as adjuvant therapy), metastatic breast cancer, non-small cell lung cancer (in combination with cisplatin), and AIDS-related Kaposi's sarcoma as a second-line treatment.Paclitaxel protein-bound particles for injectable suspension (albumin-bound) — sold as Abraxane and related products — is approved for metastatic breast cancer after prior chemotherapy, locally advanced or metastatic non-small cell lung cancer (in combination with carboplatin) as first-line treatment, and metastatic adenocarcinoma of the pancreas (in combination with gemcitabine) as first-line treatment.
These albumin-bound products are not interchangeable with other paclitaxel formulations.
Clinical overview from our editorial drug guide for Paclitaxel. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$6.586
Est. ASP / unit
$6.213 est.
Est. after 2% sequester
$6.454
HCPCS dosage
1 MG
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), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, paclitaxel protein-bound particles, 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 date2007-01-01
Date added2006-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9264 = 1 mg. Enter a regimen to convert dose → billing units and project a full course.
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 J9264 WITH EST. MEDICARE PAY
11 NDCs map to J9264. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($6.586/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00480-3290-01 | Paclitaxel 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | Teva | 1 VIAL, SINGLE-DOSE in 1 CARTON (0480-3290... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 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 | $658.60 | — | ● Active | CMS + PDAC |
| 00781-3531-91 | Paclitaxel 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | Sandoz | 1 VIAL, SINGLE-DOSE in 1 CARTON (0781-3531... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 24979-0710-51 | Paclitaxel Protein-Bound | TWI | — | — | 100 | $658.60 | — | — | CMS + PDAC |
| 60505-6230-04 | Paclitaxel Protein-Bound | Apotex | — | — | 100 | $658.60 | — | — | CMS + PDAC |
| 67457-0937-50 | PACLITAXEL 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | Mylan | 20 mL in 1 VIAL (67457-937-50) | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 68001-0651-37 | Paclitaxel protein-bound particles for injectable suspension (albumin-bound) 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | BluePoint | 1 VIAL, SINGLE-USE in 1 CARTON (68001-651-... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 68817-0134-50 | ABRAXANE Paclitaxel 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | Abraxis | 1 VIAL, SINGLE-USE in 1 CARTON (68817-134-... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 69097-0398-78 | Paclitaxel protein-bound particles 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | Cipla | 1 VIAL, SINGLE-DOSE in 1 CARTON (69097-398... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 71288-0183-50 | Paclitaxel protein-bound particles for injectable suspension (albumin-bound) 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | Meitheal | 1 VIAL, SINGLE-USE in 1 CARTON (71288-183-... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + PDAC |
| 72603-0408-01 | Paclitaxel protein-bound particles for injectable suspension (albumin-bound) 100 mg/20mL INJECTION, POWDER, LYOPHILIZED, FOR SUSPENSION | NorthStar | 1 VIAL, SINGLE-USE in 1 CARTON (72603-408-... | 100 mg/20mL | 100 | $658.60 | — | ● Active | CMS + 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.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$42.14M
Claims
21,913
Beneficiaries
6,215
Spend / beneficiary
$6,780.49
Spend / claim
$1,923.09
Trend by period
Where J9264 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #75 of 824
#70
ADCETRIS J9042
$46.69M
#71
OSENVELT* Q5157
$45.19M
#72
ERBITUX J9055
$44.95M
#73
ELIGARD* J9217
$43.65M
#74
VYALEV J7356
$43.08M
#75
ABRAXANE* J9264
$42.14M
#76
COMIRNATY * 91320
$42.06M
#77
VECTIBIX J9303
$41.65M
#78
MONOFERRIC J1437
$41.02M
#79
TALVEY J3055
$40.41M
#80
YUPELRI J7677
$40.3M
Total claims — #97 of 824
#92
BUPIVACAINE HCL* J0665
24,071
#93
BCG (TICE STRAIN)(J9... J9030
23,898
#94
ELUCIREM* A9573
23,837
#95
OHTUVAYRE J7601
22,564
#96
LEUCOVORIN CALCIUM J0640
21,924
#97
ABRAXANE* J9264
21,913
#98
GRANISETRON HCL J1626
21,847
#99
DEXTENZA J1096
21,748
#100
POSFREA J2468
21,414
#101
CAPECITABINE* J8522
21,052
#102
NUCALA J2182
20,909
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $42.14M | 6,215 | 21,913 | $6,780.49 | $1,923.09 |
| 2025 (Q1-Q4) | $274.31M | 14,514 | 94,432 | $18,899.98 | $2,904.89 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$96.55M
Medicare paid
$74.67M
Submitted services
8,201,980
Denial rate
4.3%
Allowed / service
$12.30
Submitted charges
$300.42M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗺️ Where J9264 is utilized CMS · BY PROVIDER · 2024
Medicare Part B services for this code by the rendering provider's state — 840,201 services across 22 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 J9264
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
NDC products by labeler
🗃️ 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)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk + DMEPDAC (PDAC)
11 NDCs 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
Latest data year 2026
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.
❓ J9264 billing FAQ
What is HCPCS code J9264?
J9264 is a HCPCS Level II J-code used to bill Injection, paclitaxel protein-bound particles, 1 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9264?
One unit of J9264 represents 1 MG. Report the number of units equal to the dose administered divided by 1 MG.
How many units of J9264 should I bill?
Divide the dose administered by the code's unit size (1 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J9264?
The Medicare Part B payment limit is $6.586 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $6.454 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9264?
11 NDCs currently map to J9264 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 J9264 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.
For professional billing reference only — verify against the current CMS files before submitting claims.