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    v1.0.28
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9294-pemetrexed-hospira-10mg-injection
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    HCPCS Level II J9294: Pemetrexed Injection, 10 mg

    HCPCS Level II code J9294 represents a 10 mg vial of pemetrexed (Hospira) for injection, identified as not therapeutically equivalent to J9305; the service is chemotherapy drug administration typically billed for infusion services in outpatient oncology clinics, hospital outpatient departments, or infusion centers where systemic antineoplastic therapy is provided.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugCommon code for the infusion administration time frame when J9294 is administered as the primary agent.
    96415Chemotherapy administration, intravenous infusion technique; each additional hourBilled when the infusion session for J9294 extends beyond the first hour.
    96365Intravenous infusion, therapeutic, prophylactic, or diagnostic; initial, up to 1 hourUsed for infusion of intravenous medications when chemotherapy-specific codes are not applicable or for certain supportive agents given during the same encounter.
    36415Collection of venous blood by venipuncturePerformed for pre‑ and post‑treatment laboratory monitoring (CBC, renal function) relevant to safe dosing of J9294.
    36561Therapeutic, prophylactic, or diagnostic injection; intrapleuralMay be used for procedures related to malignant pleural effusion management in patients receiving pemetrexed for mesothelioma, when intrapleural therapy is performed.

    Related Modifiers

    5 rows

    ModifierDescriptionWhen to Use
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    82Modifier 82 is appended to a surgical CPT code to indicate that an attending physician acted as an assistant because a qualified resident surgeon was unavailable. In teaching hospitals it documents…- When to use: Append modifier 82 in teaching-hospital settings to indicate a physician served as an assistant surgeon because a qualified resident surgeon was unavailable (includes situations where…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207Q00000XFamily Medicine PhysicianFamily Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadt…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    363LP2300XPrimary Care Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers · Nurse Practitioner
    3336C0002XClinic PharmacyA pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
    247200000XOther TechnicianA collective term for persons with specialized training in various narrow fields of expertise whose occupations require training and skills in specifi…
    1835G0303XGeriatric PharmacistA pharmacist who is certified in geriatric pharmacy practice is designated as a "Certified Geriatric Pharmacist" (CGP). To become certified, candidat…
    246ZB0302XBiomedical PhotographerNone
    261QA1903XAmbulatory Surgical Clinic/CenterAmbulatory Health Care Facilities · Clinic/Center

    Related ICD-10-CM Codes

    29 rows

    ICD-10-CM CodeDescription
    C15.9Malignant neoplasm of esophagus, unspecified
    C16.9Malignant neoplasm of stomach, unspecified
    C18.9Malignant neoplasm of colon, unspecified
    C19Malignant neoplasm of rectosigmoid junction
    C20Malignant neoplasm of rectum
    C22.0Liver cell carcinoma
    C25.9Malignant neoplasm of pancreas, unspecified
    C34.01Malignant neoplasm of right main bronchus
    C34.02Malignant neoplasm of left main bronchus
    C34.10Malignant neoplasm of upper lobe, unspecified bronchus or lung

    Showing 1–10 of 29

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J9000-DOXORUBICIN-10MG-INJECTION

    HCPCS J9000: Doxorubicin Hydrochloride Injection, 10 mg

    HCPCS-J9003-LEUPROLIDE-INJECTABLE-CAMCEVI-1MG

    HCPCS Level II J9003: Leuprolide injectable (camcevi etm), 1 mg

    HCPCS-J9010-ALEMTUZUMAB-INJECTION-10MG

    HCPCS Level II J9010: Injection, alemtuzumab, 10 mg

    HCPCS-J9011-DATOPOTAMAB-DERUXTECAN-INJECTION-1MG

    HCPCS J9011: Datopotamab Deruxtecan Injection, 1 mg

    HCPCS-J9015-ALDESLEUKIN-INJECTION-SINGLE-USE-VIAL

    HCPCS Level II J9015: Aldesleukin Injection, Single-Use Vial

    HCPCS-J9017-ARSENIC-TRIOXIDE-INJECTION-1MG

    HCPCS J9017: Arsenic Trioxide Injection, 1 mg

    HCPCS-J9019-ASPARAGINASE-ERWINAZE-INJECTION-1000-IU

    HCPCS Level II J9019: Asparaginase (Erwinaze) Injection, 1,000 IU

    HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

    HCPCS J9020: Asparaginase Injection, 10,000 Units

    HCPCS-J9021-ASPARAGINASE-RYLAZE-INJECTION-0-1-MG

    HCPCS Level II J9021: Injection, asparaginase (Rylaze), 0.1 mg

    HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

    HCPCS J9022: Injection, atezolizumab 10 mg

    Showing 1–10 of 227

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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