Summary & Overview
HCPCS J9314: Pemetrexed (Teva) 10 mg Injection
HCPCS Level II code J9314 denotes a 10 mg injection of pemetrexed (Teva), identified as not therapeutically equivalent to J9305. This HCPCS code matters nationally because pemetrexed is a commonly used antineoplastic agent for several oncology indications; distinct product-level codes affect billing, formularies, and payer coverage determinations. The analysis covers major national payers and Medicare to reflect common benefit designs and reimbursement practices.
Key payers included in the discussion are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of what J9314 represents clinically and operationally, typical sites of service where the drug is administered, and the context for billing this non-equivalent product unit. The publication also outlines benchmarking considerations, common billing modifiers associated with HCPCS drug administration (listed in metadata), and where to find policy or coverage updates relevant to product-specific HCPCS coding.
This summary provides clinicians, billing teams, and policy analysts a focused reference on the code’s clinical role and payer landscape, plus pointers for detailed benchmarking and policy review. Data not available in the input is explicitly noted where applicable.
Billing Code Overview
HCPCS Level II code J9314 represents an injection of pemetrexed (Teva), not therapeutically equivalent to J9305, in a 10 mg unit. This code is used to bill for administration of the specified pemetrexed product formulation.
Service type: injectable chemotherapy/antineoplastic agent.
Typical site of service: hospital outpatient department, physician office, or infusion center.
Clinical & Coding Specifications
Clinical Context
A 62-year-old patient with newly diagnosed advanced non‑small cell lung cancer (NSCLC) is scheduled to receive pemetrexed chemotherapy as part of a combination or maintenance regimen. The medication billed with J9314 (pemetrexed, Teva, 10 mg units) is prepared by the infusion pharmacy, verified by the oncology nurse, and administered intravenously in an outpatient oncology infusion center. Pre‑treatment evaluation includes review of recent labs (complete blood count, renal function, hepatic panel), confirmation of folic acid and vitamin B12 supplementation, and assessment for contraindications. The workflow includes: physician order entry with diagnosis and dose, pharmacy compounding and batch labeling in milligrams/10 mg units, verification of lot and expiry, nursing administration via peripheral IV or implanted port, documentation of lot number and units administered, and post‑infusion monitoring for immediate adverse effects. Typical sites of service are hospital outpatient departments and independent physician office infusion centers. Payers commonly involved in authorization and claims adjudication include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, and Medicare.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug amount discarded/not administered | Report when part of the single‑use vial dose is discarded and must be documented. |