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HCPCS J9264 · Level II · Part B drug

HCPCS J9264: Injection, paclitaxel protein-bound particles, 1 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 J9264

Billing unit
1 MG
Paclitaxel protein bound
ASP payment limit
$3.64
October 2026; -44.7% vs July 2026
Practitioner MUE
800
MAI 3
OPPS status
SI K
APC 1712
NCCI exposure
no PTP pairs
Coverage articles
1
5 states

TL;DR

HCPCS J9264 is the Level II code for Injection, paclitaxel protein-bound particles, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $3.64 per billing unit, down 44.7% from July 2026. The practitioner MUE allows up to 800 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 1712. With a 1 mg billing unit, a single administration can be hundreds of units; the unit count on the claim must equal the milligrams given, and rounding rules for partial units follow the contractor's guidance. The ASP crosswalk maps 11 NDCs to it, sold as Paclitaxel Protein-Bound (American Regent), Paclitaxel Protein-Bound, Paclitaxel Protein-Bound Particles by Teva Pharmaceuticals USA, Inc., American Regent, Inc., Sandoz Inc.. 1 Medicare coverage article lists the code across 5 states, including .

Medicare Part B payment limit (ASP)

CMS sets the Part B payment limit for J9264 at $3.64 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $6.586 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9264
QuarterPayment limitPerCoinsurance
October 2026$3.641 MG20%
July 2026$6.5861 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 11 NDCs from 11 labelers to J9264. Report the NDC in the claim's drug segment and bill the number of J9264 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J9264
NDCDrug nameLabelerPackage sizeBilling units / package
00480-3290-01Paclitaxel Protein-Bound (American Regent)Teva Pharmaceuticals USA, Inc.1 × 1100
00517-4300-01Paclitaxel Protein-BoundAmerican Regent, Inc.1 × 1100
00781-3531-91Paclitaxel Protein-Bound ParticlesSandoz Inc.1 × 1100
24979-0710-51Paclitaxel Protein-BoundTWI Pharmaceuticals, Inc.1 × 1100
60505-6230-04Paclitaxel Protein-BoundApotex Corp1 × 1100
67457-0937-50Paclitaxel Protein-Bound ParticlesMylan Institutional LLC1 × 1100
68001-0651-37Paclitaxel Protein-BoundBluePoint Laboratories1 × 1100
68817-0134-50AbraxaneCelgene Corporation1 × 1100
69097-0398-78Paclitaxel Protein-BoundCipla USA, Inc.1 × 1100
71288-0183-50Paclitaxel Protein-BoundMeitheal Pharmaceuticals Inc.1 × 1100
72603-0408-01Paclitaxel Protein-Bound ParticlesNorthstar RxLLC1 × 1100

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9264. For practitioners the limit is 800 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 J9264 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services8003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital8003 Date of Service Edit: ClinicalPrescribing Information
DME supplier8003 Date of Service Edit: ClinicalPrescribing Information

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9264 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.

J9264 is neither an add-on code nor a designated primary code in the 2026 Q4 NCCI add-on edit file.

Medicare coverage articles

1 current Medicare Administrative Contractor article lists J9264 in their HCPCS tables, covering 5 states. Each article carries the covered and non-covered ICD-10 codes that medical-necessity denials (CARC 50) are adjudicated against.

Billing and Coding Articles listing J9264
ArticleTitleContractor(s)StatesRelated LCD
Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)Wellpoint FederalCT IL MN NY WIL33394

Hospital outpatient (OPPS) status

In the July 2026 OPPS Addendum B, J9264 carries status indicator K and is assigned to APC 1712, with a published national unadjusted payment of $6.59. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J9264 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 J9264 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.

Explore QuickCodeExplore QuickRCMBook a demo

Frequently asked questions — HCPCS J9264

What does HCPCS code J9264 describe?

J9264 is defined by CMS as "Injection, paclitaxel protein-bound particles, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9264 in October 2026?

The ASP-based payment limit is $3.64 per 1 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $6.586.

How many units of J9264 can be billed per day?

The practitioner Medically Unlikely Edit is 800 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 J9264?

The October 2026 ASP crosswalk lists 11 NDCs from 11 labelers: Paclitaxel Protein-Bound (American Regent) (Teva Pharmaceuticals USA, Inc.); Paclitaxel Protein-Bound (American Regent, Inc.); Paclitaxel Protein-Bound Particles (Sandoz Inc.); Paclitaxel Protein-Bound (TWI Pharmaceuticals, Inc.). For example NDC 00480-3290-01 is a 1 package equal to 100 billing units. The crosswalk's billing-units-per-package figure converts each package into J9264 units.

Does J9264 have NCCI bundling edits?

No active practitioner PTP pairs list J9264 as a column-1 or column-2 code in the v323r0 release. Unit limits (MUE) and medical-necessity coverage rules still apply.

Which Medicare coverage articles mention J9264?

1 current Billing and Coding Article in the Medicare Coverage Database list J9264, covering 5 states: (Billing and Coding: Paclitaxel (e.g., Taxol®/Abraxane ™)).

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.