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HCPCS J9305 · Level II · Part B drug

HCPCS J9305: Injection, pemetrexed, not otherwise specified, 10 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 J9305

Billing unit
10 MG
Inj. pemetrexed nos 10mg
ASP payment limit
$1.23
October 2026; -82.3% vs July 2026
Practitioner MUE
150
MAI 3
OPPS status
SI K
APC 9213
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9305 is the Level II code for Injection, pemetrexed, not otherwise specified, 10 mg, billed per 10 MG. The Medicare Part B ASP payment limit for October 2026 is $1.23 per billing unit, down 82.3% from July 2026. The practitioner MUE allows up to 150 units per date of service (MAI 3). Under OPPS it carries status indicator K in APC 9213. The 10 mg billing unit means doses are reported in multiples of ten milligrams, with any remainder rounded per contractor policy; mismatched units against the NDC quantity trigger MUE and NDC-unit edits. The ASP crosswalk maps 42 NDCs to it, sold as Alimta, Pemetrexed by Eli Lilly and Company, Sagent Pharmaceuticals, Dr. Reddy's Laboratories Inc.. No current Billing and Coding Article lists J9305, 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 J9305 at $1.23 per 10 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $6.952 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9305
QuarterPayment limitPerCoinsurance
October 2026$1.2310 MG20%
July 2026$6.95210 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 42 NDCs from 13 labelers to J9305. Report the NDC in the claim's drug segment and bill the number of J9305 units that equals the quantity administered divided by 10 MG; the last column gives units per full package.

NDCs that crosswalk to J9305
NDCDrug nameLabelerPackage sizeBilling units / package
00002-7623-01AlimtaEli Lilly and Company1 × 150
00002-7640-01AlimtaEli Lilly and Company1 × 110
25021-0260-10PemetrexedSagent Pharmaceuticals1 × 110
25021-0261-50PemetrexedSagent Pharmaceuticals1 × 150
43598-0370-74PemetrexedDr. Reddy's Laboratories Inc.1 × 1100
43598-0386-62PemetrexedDr. Reddy's Laboratories Inc.1 × 110
43598-0387-11PemetrexedDr. Reddy's Laboratories Inc.1 × 150
50742-0341-01PemetrexedIngenus Pharmaceuticals LLC1 × 150
55150-0381-01PemetrexedEugia US LLC1 × 110
55150-0382-01PemetrexedEugia US LLC1 × 150
55150-0383-01PemetrexedEugia US LLC1 × 1100
60505-6065-00PemetrexedApotex Corp1 × 110
60505-6066-00PemetrexedApotex Corp1 × 150
60505-6067-00PemetrexedApotex Corp1 × 1100
60505-6068-00PemetrexedApotex Corp1 × 175
63323-0134-10PemetrexedFreseniUS Kabi USA, LLC1 × 110
63323-0450-50PemetrexedFreseniUS Kabi USA, LLC1 × 150
68001-0535-41PemetrexedBluePoint Laboratories1 × 110
68001-0536-41PemetrexedBluePoint Laboratories1 × 150
68001-0538-41PemetrexedBluePoint Laboratories1 × 110
68001-0539-41PemetrexedBluePoint Laboratories1 × 150
68001-0543-41PemetrexedBluePoint Laboratories1 × 110
68001-0544-41PemetrexedBluePoint Laboratories1 × 150
68001-0545-41PemetrexedBluePoint Laboratories1 × 175
68001-0546-41PemetrexedBluePoint Laboratories1 × 1100
70069-0834-01PemetrexedSomerset Pharma, LLC1 × 110
70069-0835-01PemetrexedSomerset Pharma, LLC1 × 150
70710-1654-01PemetrexedZydus Pharmaceuticals (USA) Inc.1 × 110
70710-1655-01PemetrexedZydus Pharmaceuticals (USA) Inc.1 × 150
70710-1674-01PemetrexedZydus Pharmaceuticals (USA) Inc.1 × 1100
70860-0202-10PemetrexedAthenex Pharmaceutical Division, LLC1 × 110
70860-0203-50PemetrexedAthenex Pharmaceutical Division, LLC1 × 150
71288-0147-50PemetrexedMeitheal Pharmaceuticals Inc.1 × 175
71288-0148-51PemetrexedMeitheal Pharmaceuticals Inc.1 × 1100
71288-0166-10PemetrexedMeitheal Pharmaceuticals Inc.1 × 110
71288-0166-91PemetrexedMeitheal Pharmaceuticals Inc.1 × 110
71288-0166-92PemetrexedMeitheal Pharmaceuticals Inc.1 × 110
71288-0167-50PemetrexedMeitheal Pharmaceuticals Inc.1 × 150
71288-0167-95PemetrexedMeitheal Pharmaceuticals Inc.1 × 150
71288-0167-96PemetrexedMeitheal Pharmaceuticals Inc.1 × 150
72603-0325-01PemetrexedNorthstar RxLLC1 × 110
72603-0425-01PemetrexedNorthstar RxLLC1 × 150

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9305. For practitioners the limit is 150 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 J9305 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1503 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1503 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 J9305 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.

J9305 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 J9305 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, J9305 carries status indicator K and is assigned to APC 9213, with a published national unadjusted payment of $6.95. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Common denials for J9305 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 J9305 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 J9305

What does HCPCS code J9305 describe?

J9305 is defined by CMS as "Injection, pemetrexed, not otherwise specified, 10 mg". Each billing unit represents 10 MG, so the units reported on the claim must equal the dose administered divided by that unit.

What is the Medicare reimbursement for J9305 in October 2026?

The ASP-based payment limit is $1.23 per 10 MG, with 20% beneficiary coinsurance. Medicare Administrative Contractors apply this limit; commercial payers use their own fee schedules. The July 2026 limit was $6.952.

How many units of J9305 can be billed per day?

The practitioner Medically Unlikely Edit is 150 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 J9305?

The October 2026 ASP crosswalk lists 42 NDCs from 13 labelers: Alimta (Eli Lilly and Company); Pemetrexed (Sagent Pharmaceuticals); Pemetrexed (Dr. Reddy's Laboratories Inc.); Pemetrexed (Ingenus Pharmaceuticals LLC). For example NDC 00002-7623-01 is a 1 package equal to 50 billing units. The crosswalk's billing-units-per-package figure converts each package into J9305 units.

Does J9305 have NCCI bundling edits?

No active practitioner PTP pairs list J9305 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.