Summary & Overview
HCPCS Level II J9304: Pemetrexed (Pemfexy) Injection, 10 mg
HCPCS Level II code J9304 designates a 10 mg injection of pemetrexed (Pemfexy), a systemic chemotherapeutic agent used in oncology. Nationally, accurate coding for high-cost oncology drugs like pemetrexed is critical for billing transparency, payer coverage determinations, and care coordination across outpatient infusion centers and hospital outpatient departments.
This analysis covers common national payers including Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find concise benchmarks for code usage and reimbursement patterns, a summary of relevant policy considerations for drug administration billing, and the clinical context necessary to understand where J9304 fits in treatment regimens. The publication also outlines typical sites of service and operational considerations for infusion delivery.
The content is intended for administrators, billing professionals, and policy analysts seeking a national-level briefing on coding and billing practices for pemetrexed injections. Data not available in the input is noted where applicable.
Billing Code Overview
HCPCS Level II code J9304 represents an injection of pemetrexed (Pemfexy), 10 mg. This code denotes administration of the chemotherapeutic agent pemetrexed, typically used in oncology for treatment of certain cancers such as non‑small cell lung cancer and malignant pleural mesothelioma.
Service Type: Injection, chemotherapy agent
Typical Site of Service: Infusion center or hospital outpatient infusion clinic
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with newly diagnosed advanced non–small cell lung cancer (NSCLC) is scheduled to receive systemic chemotherapy with a pemetrexed-based regimen. The oncology clinic administers J9304 (injection, pemetrexed (pemfexy), 10 mg) as part of the treatment cycle. Prior to infusion, nursing verifies patient identity, reviews recent labs (complete blood count, renal function), confirms folic acid and vitamin B12 supplementation per pemetrexed protocol, and documents premedication and any prior adverse reactions. The pharmacy compounds the weight-based dose from single-dose vials and provides it to the infusion nurse under sterile technique. The drug is administered via peripheral IV or implanted port in an outpatient infusion center; observation for infusion reactions occurs during and for a period after administration. Documentation includes dose (mg), units billed with J9304 (number of 10 mg units), lot number, expiration, route, site of service, performing clinician, and any applicable modifier(s) for billing (for example, if the dose was wasted or if an unusual procedural service occurred). Typical payors include Medicare, Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and other commercial plans.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered to any patient |