Summary & Overview
HCPCS J9264: Paclitaxel Protein-Bound Injection, 1 mg
HCPCS Level II code J9264 denotes the injectable chemotherapy agent paclitaxel protein-bound particles, billed per 1 mg unit. This code captures administration of albumin-bound paclitaxel (nab-paclitaxel), a formulation used in multiple oncology settings. Nationally, accurate coding for this agent matters for clinical documentation, appropriate reimbursement, and tracking utilization of a high-cost biologic chemotherapy.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for the drug, typical sites of service where the product is administered, and the common payer landscape relevant to coverage and billing. The publication summarizes benchmarks and payment policy considerations, highlights typical billing workflows for an injectable chemotherapy agent, and outlines areas where payers commonly apply clinical edits or utilization management. Where specific data elements were not provided, the report notes missing inputs.
This summary serves clinicians, billing professionals, and policy analysts seeking a national perspective on coding and billing for J9264, including how the code is used in outpatient infusion settings and what payers typically cover in broad terms.
Billing Code Overview
HCPCS Level II code J9264 represents an injection of paclitaxel protein-bound particles, 1 mg. This code is used to bill for the administration of paclitaxel formulated as albumin-bound nanoparticles (commonly known as nab-paclitaxel) measured per milligram.
Service type: injectable chemotherapy agent
Typical site of service: hospital outpatient department, physician office infusion suite, or outpatient infusion center
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
Service: J9264 — Injection, paclitaxel protein-bound particles, 1 mg.
A typical patient is an adult with metastatic breast cancer or other solid tumor for which nanoparticle albumin-bound paclitaxel (nab‑paclitaxel) is indicated. The patient presents to an outpatient oncology infusion center for systemic chemotherapy administration. Prior to infusion, the oncologist reviews indications, recent labs (complete blood count, hepatic function tests), and performance status; orders and documents the regimen, dose in mg, and cycle number. The pharmacy compounds the appropriate dose using J9264 units and performs sterile preparation and labeling. A registered nurse verifies identity, obtains baseline vital signs, and starts an intravenous line. Pre‑medications (antiemetic, corticosteroid if used per protocol) are administered as indicated. The J9264 drug is infused per facility protocol over the prescribed infusion time with monitoring for hypersensitivity and infusion‑related reactions. Post‑infusion assessment and documentation include vitals, adverse event assessment, and disposition. Billing uses J9264 units corresponding to the milligram dose administered, appended with appropriate modifiers to reflect payer requirements, drug wastage, or special circumstances.
Coding Specifications
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