Summary & Overview
HCPCS Level II J9292: Pemetrexed Dipotassium Injection, 10 mg
HCPCS Level II code J9292 denotes a 10 mg injectable unit of pemetrexed dipotassium, an antineoplastic agent commonly used in chemotherapy regimens. The code is important nationwide because it standardizes billing for a high-cost specialty oncology drug administered by infusion, facilitating claims processing, coverage decisions, and price benchmarking across payers. Key payers considered in this analysis include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the clinical context for pemetrexed administration, expected sites of service (hospital outpatient infusion centers and physician office infusion suites), and the types of benchmarks and policy elements typically relevant to this HCPCS Level II code. The publication summarizes reimbursement benchmarks, common billing practices, and payer policy considerations that affect coverage and prior authorization. It also outlines areas where policy updates and coding guidance are commonly applied for injectable oncology drugs. Data not available in the input is noted where specific payer rates, associated taxonomies, ICD-10 pairings, and related codes would normally be presented.
Billing Code Overview
HCPCS Level II code J9292 represents an injectable formulation of pemetrexed dipotassium, 10 mg. This code is used to report administration of the pemetrexed active drug supplied in 10 mg increments for intravenous oncology treatment.
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Service type: Injectable antineoplastic agent
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Typical site of service: Hospital outpatient infusion center or physician office infusion suite
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a diagnosis of non–small cell lung cancer, malignant pleural mesothelioma, or other pemetrexed‑sensitive solid tumor undergoing systemic chemotherapy. The patient presents to an outpatient oncology infusion center or hospital outpatient infusion clinic for cycle treatment. Prior to administration, the oncology nurse verifies patient identity, recent laboratory results (especially renal function and complete blood count), and premedication orders (folic acid, vitamin B12, and dexamethasone) per institutional protocol. The medication order specifies J9292 dosed per body surface area and prepared by the infusion pharmacy as a preservative‑free injectable vial. The drug is administered intravenously over the recommended infusion time with monitoring for infusion reactions and hematologic or renal toxicity. Documentation includes consent, indication, drug lot and expiration, exact dose administered (units of 10 mg), start and stop times, site of service, applicable modifier(s), and any adverse events. Typical site of service is an outpatient oncology infusion center, hospital outpatient infusion department, or occasionally an inpatient oncology ward for patients requiring admission.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
00 | Service furnished without a professional component | Rare for drug administration; typically not used for chemotherapy drug codes |