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    v1.0.28
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9304-pemetrexed-injection-10mg
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    HCPCS Level II J9304: Pemetrexed Injection, 10 mg

    HCPCS Level II code J9304 describes an injection of pemetrexed (Pemfexy) in a 10 mg single-unit drug formulation used for chemotherapy administration; the service is an antineoplastic drug injection typically provided in outpatient oncology settings such as hospital outpatient departments, infusion centers, and physician offices.

    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 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.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/agentUsed to report the infusion administration time for the initial or single-agent infusion session when J9304 is administered intravenously.
    96415Chemotherapy administration, intravenous infusion technique; each additional hourUsed when the infusion session for pemetrexed extends beyond the first hour and additional time-based infusion reporting is required.
    96417Chemotherapy administration, intravenous infusion technique; additional sequential infusion of a new drug, up to 1 hourUsed when an additional non-compatible agent is infused sequentially during the same visit following J9304.
    96401Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplasticUsed when the route differs from IV and a qualifying injectable antineoplastic is given via IM/SC route (less common for pemetrexed).
    36561Long-term maintenance of central venous catheter, infusion catheter care, injection, or catheter flushUsed for access device maintenance or care when an implanted port or central venous catheter is used for pemetrexed administration.

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    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…
    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…
    22Modifier –22 (Increased Procedural Services) is used when a reported procedure is substantially more extensive than normally required. The CPT Manual and CMS state it may be appended only when the…- When to use: Append modifier -22 to a procedural CPT code when the service performed is substantially more extensive than the usual service described by that code — i.e., the procedure required…
    23Modifier -23 (Unusual Anesthesia) is used on anesthesia service CPT codes when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia…- Use modifier -23 only on anesthesia CPT codes (00100–01999) when a procedure that normally requires no anesthesia or only local anesthesia must be performed under general anesthesia because of…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    56Modifier ‑56 indicates the reporting provider furnished only the preoperative management for a surgical procedure and did not perform the intraoperative or postoperative care. It is used in…- Use Modifier -56 when a provider performs only the preoperative management in a split‑care situation (one physician manages preop care while a different physician performs the intraoperative…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0000XHematology (Internal Medicine) PhysicianAn internist with additional training who specializes in diseases of the blood, spleen and lymph. This specialist treats conditions such as anemia, cl…
    363L00000XNurse Practitioner(1) A registered nurse provider with a graduate degree in nursing prepared for advanced practice involving independent and interdependent decision mak…
    3336C0002XClinic PharmacyA pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…
    208D00000XGeneral Practice PhysicianA physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.
    364SP0200XPediatric Clinical Nurse SpecialistPhysician Assistants & Advanced Practice Nursing Providers · Clinical Nurse Specialist
    124Q00000XDental HygienistAn individual who has completed an accredited dental hygiene education program, and an individual who has been licensed by a state board of dental exa…
    261QM2800XMethadone ClinicAn entity, facility, or distinct part of a facility providing diagnostic, and replacement maintenance treatment services related to individuals with d…
    2081P0004XSpinal Cord Injury Medicine PhysicianA physician who addresses the prevention, diagnosis, treatment and management of traumatic spinal cord injury and non-traumatic etiologies of spinal c…

    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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