Summary & Overview
HCPCS J9294: Pemetrexed (Hospira) Injection, 10 mg
HCPCS Level II code J9294 represents a 10 mg injectable formulation of pemetrexed (Hospira) specifically designated as not therapeutically equivalent to J9305. This code is used to bill for the medication product itself when administered as an antineoplastic agent, typically in hospital outpatient infusion centers or oncology clinics. Nationally, accurate coding of specific drug formulations matters for correct billing, inventory tracking, and payer adjudication, especially when therapeutically non-equivalent products are distinguished.
Key payers commonly included in analyses of this code are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find an overview of clinical context for pemetrexed administration, typical sites of service, and the implications of a non-therapeutic-equivalence designation. The publication also summarizes what to expect in payer coverage patterns, common modifier usage (listed separately), and relevant coding considerations. Where available, benchmarks and policy updates affecting HCPCS drug coding and reimbursement practices are outlined. Data not provided in the input are noted as unavailable and are omitted from the summary.
Billing Code Overview
HCPCS Level II code J9294 describes an injection formulation of pemetrexed (Hospira) labeled as not therapeutically equivalent to J9305, in a 10 mg unit. The code is a drug administration billing code for the specified oncology medication formulation.
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Service type: Drug injection/infusible chemotherapeutic agent
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Typical site of service: Hospital outpatient infusion center or oncology clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with advanced non–small cell lung cancer or malignant pleural mesothelioma presenting for systemic chemotherapy. The patient arrives to an outpatient oncology infusion center or hospital outpatient department for administration of intravenous pemetrexed. Pre-infusion workflow includes verification of diagnosis, review of prior laboratory results (complete blood count, renal function), confirmation of folic acid and vitamin B12 supplementation, consent, and chemotherapy order verification by the oncology pharmacist. The infusion nurse performs IV access placement or assesses an existing central venous catheter, reviews premedication needs (eg, corticosteroids for rash prophylaxis), and prepares the reconstituted J9294 vial for weight‑based dosing. Post‑administration monitoring includes observation for infusion reactions, documentation of lot number and vial wastage (if any), and scheduling of follow‑up labs and subsequent cycles in the oncology clinic. Typical site of service is an outpatient infusion center or hospital outpatient department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug/biological discarded unused portion | Report when part of the J9294 vial is wasted and documentation of amount discarded is present. |