Summary & Overview
HCPCS J9305: Injection, pemetrexed, 10 mg
HCPCS Level II code J9305 designates a 10 mg unit of pemetrexed for injection, an antineoplastic agent commonly used in oncology care. As a unit-based drug code, J9305 is significant for national chemotherapy billing, inventory management, and payer payment policies because it defines how pemetrexed is reported on outpatient and infusion service lines.
Key payers included in this overview are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise national perspective on clinical context, typical sites of service, and the role of unit-based HCPCS reporting for pemetrexed. The publication outlines what to expect in benchmarks and payment policy considerations at a national level and clarifies the service classification for claims and billing teams.
This document is intended to inform coding, billing, and revenue cycle stakeholders about how J9305 is used on service lines, where the service is typically delivered, and which major payers are relevant for national policy and coverage considerations. Data not provided in the input are noted explicitly where applicable.
Billing Code Overview
HCPCS Level II code J9305 represents an injection of pemetrexed supplied as a 10 mg unit, used for antineoplastic chemotherapy administration. The billing descriptor indicates the medication formulation and unit size rather than a specific dosing regimen.
Service Type: Medication administration (antineoplastic agent)
Typical Site of Service: Outpatient infusion center or hospital outpatient department
Data not available in the input.
Clinical & Coding Specifications
Clinical Context
A typical patient is an adult with a diagnosed non-small cell lung cancer or malignant pleural mesothelioma scheduled to receive systemic chemotherapy. The oncology clinic verifies diagnosis, baseline labs (CBC, renal and hepatic panels), and performance status before ordering J9305 for administration. On the day of treatment the patient is evaluated by an oncology nurse and the prescribing medical oncologist for interim toxicities, weight for dosage confirmation, and required premedications such as folic acid and vitamin B12 supplementation per pemetrexed protocol. The drug is prepared by pharmacy as an intravenous infusion and administered in an outpatient infusion center or hospital outpatient department; observation for infusion reactions and post‑treatment instructions are provided prior to discharge.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered | When a portion of the reconstituted J9305 dose is discarded and the administered portion is billed |
JZ |