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HCPCS J9201 · Level II · Part B drug

HCPCS J9201: Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg

Reviewed by QuickIntell RCM Editorial Team · Last reviewed

Data effective
Data currency: ASP payment limits October 2026 (effective October 1, 2026); MUE and NCCI edits 2026 Q4 (effective October 1, 2026); OPPS Addendum B July 2026 (effective July 1, 2026). Next CMS release: January 1, 2027 (ASP, MUE, NCCI and OPPS quarterly updates).

Key facts for J9201

Billing unit
200 MG
In gemcitabine hcl nos 200mg
ASP payment limit
$2.734
October 2026; -5.2% vs July 2026
Practitioner MUE
20
MAI 3
OPPS status
SI N
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9201 is the Level II code for Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg, billed per 200 MG. The Medicare Part B ASP payment limit for October 2026 is $2.734 per billing unit, down 5.2% from July 2026. The practitioner MUE allows up to 20 units per date of service (MAI 3). Under OPPS it carries status indicator N. J9201 is billed in units of 200 MG; the quantity administered, the NDC package and the units on the claim must reconcile, which is the check that prevents CARC 16 and 151 returns on this line. The ASP crosswalk maps 31 NDCs to it, sold as Gemcitabine by Hikma Pharmaceuticals USA Inc., Pfizer Inc, Northstar RxLLC. No current Billing and Coding Article lists J9201, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J9201 at $2.734 per 200 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $2.884 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9201
QuarterPayment limitPerCoinsurance
October 2026$2.734200 MG20%
July 2026$2.884200 MG—
Source: CMS Medicare Part B Drug Payment Limit File. Commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 ASP crosswalk maps 31 NDCs from 8 labelers to J9201. Report the NDC in the claim's drug segment and bill the number of J9201 units that equals the quantity administered divided by 200 MG; the last column gives units per full package.

NDCs that crosswalk to J9201
NDCDrug nameLabelerPackage sizeBilling units / package
00143-9340-01GemcitabineHikma Pharmaceuticals USA Inc.5.26 × 11
00143-9341-01GemcitabineHikma Pharmaceuticals USA Inc.26.3 × 15
00143-9342-01GemcitabineHikma Pharmaceuticals USA Inc.52.6 × 110
00409-0181-01GemcitabinePfizer Inc26.3 × 15
00409-0181-25GemcitabinePfizer Inc26.3 × 15
00409-0182-01GemcitabinePfizer Inc52.6 × 110
00409-0182-25GemcitabinePfizer Inc52.6 × 110
00409-0183-01GemcitabinePfizer Inc5.26 × 11
00409-0183-25GemcitabinePfizer Inc5.26 × 11
00409-0185-01GemcitabinePfizer Inc1 × 11
00409-0186-01GemcitabinePfizer Inc1 × 15
00409-0187-01GemcitabinePfizer Inc1 × 110
16714-0909-01GemcitabineNorthstar RxLLC1 × 11
16714-0930-01GemcitabineNorthstar RxLLC1 × 15
25021-0234-10GemcitabineSagent Pharmaceuticals1 × 11
25021-0235-50GemcitabineSagent Pharmaceuticals1 × 15
25021-0235-51GemcitabineSagent Pharmaceuticals1 × 1050
25021-0239-05GemcitabineSagent Pharmaceuticals5.26 × 11
25021-0239-26GemcitabineSagent Pharmaceuticals26.3 × 15
25021-0239-52GemcitabineSagent Pharmaceuticals52.6 × 110
63323-0102-13GemcitabineFreseniUS Kabi USA, LLC1 × 11
63323-0125-53GemcitabineFreseniUS Kabi USA, LLC1 × 15
67457-0616-10GemcitabineMylan Institutional LLC5.26 × 11
67457-0617-30GemcitabineMylan Institutional LLC26.3 × 15
67457-0618-10GemcitabineMylan Institutional LLC52.6 × 110
70860-0205-50GemcitabineAthenex Pharmaceutical Division, LLC1 × 15
71288-0113-10GemcitabineMeitheal Pharmaceuticals Inc.1 × 11
71288-0114-50GemcitabineMeitheal Pharmaceuticals Inc.1 × 15
71288-0117-06GemcitabineMeitheal Pharmaceuticals Inc.5.26 × 11
71288-0117-28GemcitabineMeitheal Pharmaceuticals Inc.26.3 × 15
71288-0117-54GemcitabineMeitheal Pharmaceuticals Inc.52.6 × 110

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9201. For practitioners the limit is 20 units per date of service with adjudication indicator 3, a date-of-service clinical edit: units above the limit deny but can be paid on appeal with documentation that the quantity was medically reasonable.

MUE values for J9201 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services203 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital203 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9201 as a column-1 or column-2 code in v323r0. Drug supply codes are rarely bundled; the administration codes billed with them are where PTP edits usually apply.

J9201 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

No current Billing and Coding Article lists J9201 in its HCPCS table. Coverage then follows the drug's FDA label, compendia and any National Coverage Determination; check the Medicare Coverage Database before administering off-label.

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J9201 carries status indicator N. Status N means payment is packaged into the associated procedure and no separate OPPS payment is made.

Common denials for J9201 and how to prevent them

CARC 16 · M119

NDC missing, invalid or not matched to the HCPCS code

CARC 151 · N362

units billed exceed the MUE for the date of service

CARC 50 · N115

diagnosis not covered by the applicable coverage article or LCD

How QuickIntell checks J9201 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current ASP crosswalk, checks units against every published MUE setting and flags PTP and add-on conflicts on the same claim. QuickRCM routes CARC 16, 151 and 50 denials on drug lines with the matching coverage article attached so the appeal starts with evidence.

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Frequently asked questions — HCPCS J9201

What does HCPCS code J9201 describe?

J9201 is defined by CMS as "Injection, gemcitabine hydrochloride, not otherwise specified, 200 mg". Each billing unit represents 200 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9201 in October 2026?

The ASP-based payment limit is $2.734 per 200 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $2.884.

How many units of J9201 can be billed per day?

The practitioner Medically Unlikely Edit is 20 units per date of service with adjudication indicator 3 (3 Date of Service Edit: Clinical). MAI 3 edits can be appealed with documentation that the units were medically reasonable. CMS cites "Prescribing Information" as the rationale.

Which NDCs map to J9201?

The October 2026 ASP crosswalk lists 31 NDCs from 8 labelers: Gemcitabine (Hikma Pharmaceuticals USA Inc.); Gemcitabine (Pfizer Inc); Gemcitabine (Northstar RxLLC); Gemcitabine (Sagent Pharmaceuticals). For example NDC 00143-9340-01 is a 5.26 package equal to 1 billing unit. The crosswalk's billing-units-per-package figure converts each package into J9201 units.

Does J9201 have NCCI bundling edits?

No active practitioner PTP pairs list J9201 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-01. Verify against the primary file before billing or contracting decisions.

Disclaimer

This page is an operational reference compiled from CMS publications: the Medicare Part B drug payment limit and NDC crosswalk files, NCCI MUE and add-on edit tables, aggregate PTP statistics, OPPS Addendum B and the Medicare Coverage Database. Payment limits are Medicare national amounts; commercial and Medicaid payers differ. CPT codes are shown as numbers only; CPT descriptors are copyright AMA. Nothing here is legal, clinical or billing advice.