J9294
J9294 – Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 6 NDCs crosswalked per 10 MG $2.943/unit ASP+6%
📋 J9294 summary
J9294 is a HCPCS Level II J-code used to bill pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg, billed per 10 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 J9294: Pemetrexed Disodium(J9294), Pemetrexed
Code J9294
Billing unit 10 MG Payment limit $2.943/unit NDC-Crosswalk 6
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 codeJ9294
DescriptorInjection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg
Billing unit10 MG
Payment limit / unit$2.943
Est. ASP / unit$2.776 est.
Mapped NDCs6
Data periodQ3 2026
Last updated2026-08-20
💊 About Pemetrexed Disodium DRUG GUIDE
Pemetrexed disodium injection is used to treat two types of cancer: non-squamous non-small cell lung cancer (NSCLC) and malignant pleural mesothelioma (a cancer of the lining around the lungs).
It is available under several brand and generic names, including Alimta, Pemrydi RTU, and generic pemetrexed products.For non-squamous NSCLC, it can be used in combination with pembrolizumab and platinum chemotherapy as initial treatment for metastatic disease (in patients without certain genetic mutations), with cisplatin as initial treatment for locally advanced or metastatic disease, as a single-agent maintenance treatment after first-line platinum-based chemotherapy, or as a single agent after prior chemotherapy.
It is also used with cisplatin as initial treatment for malignant pleural mesothelioma that cannot be surgically removed.
It is not approved for squamous cell non-small cell lung cancer.
Clinical overview from our editorial drug guide for Pemetrexed Disodium. 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
$2.943
Est. ASP / unit
$2.776 est.
Est. after 2% sequester
$2.884
HCPCS dosage
10 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, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 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 date2023-04-01
Date added2023-04-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9294 = 10 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 J9294 WITH EST. MEDICARE PAY
6 NDCs map to J9294. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($2.943/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 00409-0004-04 | PEMETREXED 1 g/40mL INJECTION, SOLUTION, CONCENTRATE | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0004... | 1 g/40mL | 100 | $294.30 | — | ● Active | CMS ASP |
| 00409-0020-02 | PEMETREXED 100 mg/4mL INJECTION, SOLUTION, CONCENTRATE | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0020... | 100 mg/4mL | 10 | $29.43 | — | ● Active | CMS ASP |
| 00409-0021-03 | PEMETREXED 500 mg/20mL INJECTION, SOLUTION, CONCENTRATE | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-0021... | 500 mg/20mL | 50 | $147.15 | — | ● Active | CMS ASP |
| 00409-1045-01 | PEMETREXED 100 mg/4mL INJECTION, SOLUTION, CONCENTRATE | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-1045... | 100 mg/4mL | 10 | $29.43 | — | ● Active | CMS ASP |
| 00409-2188-01 | PEMETREXED 500 mg/20mL INJECTION, SOLUTION, CONCENTRATE | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-2188... | 500 mg/20mL | 50 | $147.15 | — | ● Active | CMS ASP |
| 00409-3532-01 | PEMETREXED 1 g/40mL INJECTION, SOLUTION, CONCENTRATE | Hospira, | 1 VIAL, SINGLE-DOSE in 1 CARTON (0409-3532... | 1 g/40mL | 100 | $294.30 | — | ● Active | CMS ASP |
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
$212.3K
Claims
568
Beneficiaries
267
Spend / beneficiary
$794.97
Spend / claim
$373.69
Trend by period
Where J9294 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #521 of 824
#516
BRIXADI(J0578) J0578
$220.9K
#517
XWRAP DUAL, PER SQ C... Q4358
$220.2K
#518
CYANOCOBALAMIN INJEC... J3420
$219.2K
#519
ALBUKED-25(P9046)* P9046
$215K
#520
PRIMATRIX** Q4110
$215K
#521
PEMETREXED DISODIUM(... J9294
$212.3K
#522
BENDAMUSTINE HCL* J9033
$211.3K
#523
HYCAMTIN J8705
$208.5K
#524
UZEDY J2799
$206.9K
#525
OXALIPLATIN J9263
$201.6K
#526
ORION, PER SQ CM** Q4276
$197.2K
Total claims — #440 of 824
#435
BRIUMVI J2329
599
#436
MULTIHANCE MULTIPACK A9578
598
#437
METOCLOPRAMIDE HCL J2765
585
#438
AXTLE J9292
584
#439
HALDOL DECANOATE 100... J1631
573
#440
PEMETREXED DISODIUM(... J9294
568
#441
DEXRAZOXANE J1190
567
#442
TESTOSTERONE ENANTHA... J3121
558
#443
DELESTROGEN* J1380
557
#444
TOPOTECAN HCL J9351
553
#445
CINQAIR J2786
540
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) | $212.3K | 267 | 568 | $794.97 | $373.69 |
| 2025 (Q1-Q4) | $776.8K | 636 | 2,205 | $1,221.44 | $352.31 |
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
$1.9K
Medicare paid
$1.5K
Submitted services
675
Submitted charges
$9.6K
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.
🗃️ 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
6 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.
❓ J9294 billing FAQ
What is HCPCS code J9294?
J9294 is a HCPCS Level II J-code used to bill Injection, pemetrexed (hospira) not therapeutically equivalent to j9305, 10 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9294?
One unit of J9294 represents 10 MG. Report the number of units equal to the dose administered divided by 10 MG.
How many units of J9294 should I bill?
Divide the dose administered by the code's unit size (10 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 J9294?
The Medicare Part B payment limit is $2.943 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $2.884 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9294?
6 NDCs currently map to J9294 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 J9294 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.