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HCPCS J9322 · Level II · Part B drug

J9322: pemetrexed, HCPCS Level II J code

Compiled from CMS files by the QuickIntell RCM Editorial Team · Data effective · Method: reference methodology · Report a data correction

Data currency: OPPS Addendum B: October 2026 (effective October 1, 2026); OPPS NDC-HCPCS crosswalk: October 2026 (effective October 1, 2026); NCCI MUE tables: 2026 Q4 (effective October 1, 2026); NCCI PTP edits: v323r0 (2026 Q4) (effective October 1, 2026); ASC Addendum BB (covered ancillary services): October 2026 (effective October 1, 2026). Next CMS release: January 1, 2027 (quarterly update).

Key facts for J9322

Billing unit
10 mg
Inj pemetrexed (bluepoint)
OPPS payment rate
$10.60
no ASP limit; SI K, October 2026
Practitioner MUE
150
MAI 3
OPPS status
SI K
APC 0871
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9322 is the Level II code for Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg, billed per 10 mg. CMS publishes no ASP payment limit for it; hospital outpatient departments are paid separately under OPPS (status indicator K, $10.60 per billing unit in October 2026). The practitioner MUE allows up to 150 units per date of service (MAI 3). 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. Other HCPCS codes whose descriptor names pemetrexed: J9324 (Pemrydi rtu from Amneal Pharmaceuticals, LLC; billed per 10 mg); J9314 (the Teva product (manufacturer named in its CMS descriptor); billed per 10 mg); J9305 (not otherwise specified (for products without their own code); billed per 10 mg); J9304 (Pemfexy; billed per 10 mg); J9297 (the Sandoz product (manufacturer named in its CMS descriptor); billed per 10 mg); J9294 (the Hospira product (manufacturer named in its CMS descriptor); billed per 10 mg). No current Billing and Coding Article lists J9322, so coverage follows the FDA label, compendia and any applicable NCD.

Medicare payment: OPPS rate (no ASP limit)

J9322 does not appear in the October 2026 Part B ASP payment limit file. CMS pays it separately to hospital outpatient departments under OPPS with status indicator K in APC 0871, at a national unadjusted rate of $10.60 per 10 mg. Status K is a separately paid, non-pass-through drug or biological, including therapeutic radiopharmaceuticals. In a physician office the Medicare contractor prices the drug, often from invoice; commercial and Medicaid payers set their own rates.

NDC to HCPCS billing-unit conversion

The October 2026 OPPS crosswalk lists no NDC for J9322. Report the NDC from the product label and confirm the units conversion from the HCPCS descriptor (Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg).

Medically Unlikely Edits (MUE)

CMS publishes 2 MUE values for J9322. 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 J9322 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services1503 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital1503 Date of Service Edit: ClinicalPrescribing Information

MUE for J9322 in every setting opens the lookup with this code filled in, next to any other code on the same claim.

NCCI edits and add-on relationships

No active practitioner PTP pair lists J9322 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.

The counts above are exposure, not answers for a specific claim. Check J9322 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

J9322 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 J9322 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 October 2026 OPPS Addendum B, J9322 carries status indicator K and is assigned to APC 0871, with a published national unadjusted payment of $10.60. Status K means the drug is paid separately under OPPS rather than packaged into the procedure.

Ambulatory surgical center (ASC) payment

In the October 2026 ASC Addendum BB (covered ancillary services), J9322 carries payment indicator K2, which CMS defines as "Drugs, biologicals, and radiopharmaceuticals paid separately when provided integral to a surgical procedure on ASC list; payment based on OPPS rate". The national ASC payment is $10.60 per 10 mg, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for J9322 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 J9322 before the claim leaves

QuickCode validates the NDC-to-unit conversion against the current OPPS NDC-HCPCS 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 J9322

What does HCPCS code J9322 describe?

J9322 is defined by CMS as "Injection, pemetrexed (bluepoint), not therapeutically equivalent to j9305, 10 mg". Each billing unit represents 10 mg, so the units reported on the claim must equal the dose administered divided by that unit.

Is J9322 a CPT code?

No. J9322 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as pemetrexed; CPT codes are five-character codes maintained by the AMA. On a Part B claim J9322 reports the drug itself in 10 mg units, and the administration is billed on its own line.

What does Medicare pay for J9322 in a hospital outpatient department?

J9322 has no Part B ASP limit; the October 2026 OPPS Addendum B pays it separately under status K, APC 0871, at $10.60 per 10 mg, and ASC Addendum BB gives it payment indicator K2 at $10.60.

How many units of J9322 can be billed per day?

The practitioner Medically Unlikely Edit is 150 units per date of service with adjudication indicator 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.

Does J9322 have NCCI bundling edits?

No active practitioner PTP pairs list J9322 as a column-1 or column-2 code in the v323r0 release.

J9322 vs J9324: what is the difference?

Both are HCPCS Level II codes whose descriptor names pemetrexed. What sets J9324 apart: Pemrydi rtu from Amneal Pharmaceuticals, LLC; billed per 10 mg. J9322 is billed per 10 mg, OPPS rate $10.60, MUE 150; J9324 is billed per 10 mg, limit $63.58, MUE 150. Report the code whose descriptor matches the product and setting in the record.

J9322 vs J9314: what is the difference?

Both are HCPCS Level II codes whose descriptor names pemetrexed. What sets J9314 apart: the Teva product (manufacturer named in its CMS descriptor); billed per 10 mg. J9322 is billed per 10 mg, OPPS rate $10.60, MUE 150; J9314 is billed per 10 mg, limit $10.986, MUE 150. Report the code whose descriptor matches the product and setting in the record.

Sources

Every figure on this page is taken from the CMS publications below, as released by the Centers for Medicare & Medicaid Services. Projection built 2026-10-10. Verify against the primary file before billing or contracting decisions. The reference methodology explains how each figure is computed from these files.

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, ASC Addendum BB and the Medicare Coverage Database. Payment limits and rates 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.

Found a figure that does not match the CMS file? Report a data correction with the CMS file and the value you expected; the request reaches the editorial team through the contact form.