Summary & Overview
HCPCS J9323: Injection, pemetrexed ditromethamine, 10 mg
HCPCS Level II code J9323 denotes the injection of pemetrexed ditromethamine, measured per 10 mg unit. Pemetrexed is an antineoplastic agent commonly used in the systemic treatment of certain solid tumors, and billing for this code documents the drug units administered during infusion encounters. Nationally, accurate unit-level reporting for high-cost oncology drugs like pemetrexed is important for claims processing, cost transparency, and utilization monitoring.
Key payers included in the analysis are Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find benchmarks on unit reporting practices, payer coverage considerations, and clinical context linking the drug to infusion-based oncology care. The publication also outlines common billing modifiers and service-line implications relevant to infusion centers and hospital outpatient departments.
The report provides a concise resource for coding staff, revenue cycle managers, and policy analysts seeking a clear reference on HCPCS Level II code J9323, including where the service is typically delivered and what operational areas (drug acquisition, infusion administration, and unit-level documentation) are most affected.
Billing Code Overview
HCPCS Level II code J9323 describes the injection of pemetrexed ditromethamine, 10 mg. This code represents a chemotherapy or antineoplastic drug administration billed for each 10 mg unit of the medication.
Service Type: Drug administration — antineoplastic/chemotherapy agent
Typical Site of Service: Outpatient infusion center, hospital outpatient department, or physician office infusion suite
Data not available in the input for associated taxonomies, ICD-10 diagnoses, and related codes.
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 pemetrexed ditromethamine as part of a first‑line or maintenance regimen. The medication J9323 (Injection, pemetrexed ditromethamine, 10 mg) is prepared by the outpatient oncology infusion pharmacy, verified by an oncology pharmacist, and administered in an ambulatory infusion center or hospital outpatient infusion clinic. Typical workflow: the oncologist documents diagnosis and orders pemetrexed dose based on body surface area; nursing completes pre‑infusion assessment and confirms premedication (folic acid, vitamin B12, and dexamethasone as per protocol); pharmacy compounds the exact vial quantity and labels ancillary supplies; the patient receives intravenous infusion over the protocol‑specified time with monitoring for infusion reactions and cytopenias; after infusion, nursing documents drug lot, vial usage, and any immediate reactions. Billing uses J9323 units calculated from the total milligrams administered divided by 10 mg per unit, with appropriate diagnosis linkage to the malignant neoplasm code.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
JW | Drug discarded/returned to vial, amount not administered | Use when part of the drug is wasted and the waste must be reported separately from the administered units. |