Summary & Overview
HCPCS J9267: Injection, Paclitaxel, 1 mg
HCPCS Level II code J9267 represents the injectable chemotherapy agent paclitaxel, reported per 1 mg. Paclitaxel is a widely used cytotoxic agent in oncology, and accurate billing by milligram is important for clinical documentation, dosing transparency, and payment. Nationally, this code matters because chemotherapy drugs billed by unit can drive significant outpatient drug spend and require precise coding to align with payer coverage and medical necessity reviews.
Key payers in this overview include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise explanation of the code's clinical role and billing context, followed by benchmarking and policy considerations relevant to national reimbursement practices. The publication outlines typical sites of service (outpatient infusion centers, hospital outpatient departments, and physician office infusion suites) and highlights what to expect in payer policies: unit-based drug reporting, potential prior authorization requirements, and distinctions between drug administration codes and drug J-codes.
This summary equips billing professionals, practice managers, and policy analysts with the information needed to identify where J9267 fits in service lines, prepare for payer interactions, and understand implications for drug cost reporting and clinical documentation. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J9267 describes an injection of paclitaxel, billed per 1 mg of drug. This code represents the drug administration component for paclitaxel when the medication itself is reported by dose units.
Service Type: Drug administration / Chemotherapy agent
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or physician office infusion suite
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Clinical & Coding Specifications
Clinical Context
A 58-year-old female with newly diagnosed metastatic breast cancer is scheduled to receive intravenous chemotherapy with paclitaxel. The drug is billed using J9267 (Injection, paclitaxel, 1 mg). Typical workflow: the patient arrives to the outpatient oncology infusion center; verification of identity, chemotherapy orders, and premedications (antihistamine, corticosteroid) are confirmed by the oncology nurse; baseline vital signs and height/weight are documented for dose calculation; an intravenous access device (peripheral IV or implanted port) is assessed or accessed; the pharmacy prepares and dispenses paclitaxel in the appropriate concentration and bag according to sterile compounding standards; the infusion nurse administers the drug while monitoring for hypersensitivity reactions and infusion-related toxicities; supportive care (antiemetics, hydration) is provided as ordered; post-infusion observation occurs per protocol before discharge. Typical site of service: outpatient hospital infusion center or physician office infusion suite. Typical patient scenario: adult oncology patient receiving repeated cycles of paclitaxel for breast, ovarian, or other solid-tumor malignancy, billed per milligram using J9267 with documentation of dose, lot number, and administration details in the medical record.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW |