Skip to main content
Call AIBook a demo
HCPCS J9271 · Level II · Part B drug

J9271: pembrolizumab (Keytruda), 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: ASP payment limits: 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); OPPS Addendum B: October 2026 (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 J9271

Billing unit
1 MG
Inj pembrolizumab
ASP payment limit
$62.253
October 2026; +2.7% vs July 2026
Practitioner MUE
400
MAI 3
OPPS status
SI K
APC 1490
NCCI exposure
no PTP pairs
Coverage articles
0
none list this code

TL;DR

HCPCS J9271 is the Level II code for Injection, pembrolizumab, 1 mg, billed per 1 MG. The Medicare Part B ASP payment limit for October 2026 is $62.253 per billing unit, up 2.7% from July 2026. The practitioner MUE allows up to 400 units per date of service (MAI 3), so a full 400-unit day is $24,901.20 at the current limit. Under OPPS it carries status indicator K in APC 1490. 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. Other HCPCS codes whose descriptor names pembrolizumab: J9277 (Keytruda Qlex). The ASP crosswalk maps 2 NDCs to it, sold as Keytruda by Merck Sharp & Dohme LLC. No current Billing and Coding Article lists J9271, 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 J9271 at $62.253 per 1 MG for October 2026, derived from manufacturer average sales price plus 6%, compared with $60.645 in July 2026. Beneficiary coinsurance is 20%.

ASP payment limits for J9271
QuarterPayment limitPerCoinsurance
October 2026$62.2531 MG20%
July 2026$60.6451 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 2 NDCs from 1 labeler to J9271. Report the NDC in the claim's drug segment and bill the number of J9271 units that equals the quantity administered divided by 1 MG; the last column gives units per full package.

NDCs that crosswalk to J9271
NDCDrug nameLabelerPackage sizeBilling units / package
00006-3026-02KeytrudaMerck Sharp & Dohme LLC4 × 1100
00006-3026-04KeytrudaMerck Sharp & Dohme LLC4 × 2200

Medically Unlikely Edits (MUE)

CMS publishes 3 MUE values for J9271. For practitioners the limit is 400 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 J9271 by setting
SettingMUE (units/DOS)MAICMS rationale
Practitioner services4003 Date of Service Edit: ClinicalPrescribing Information
Facility outpatient hospital4003 Date of Service Edit: ClinicalPrescribing Information
DME supplier03 Date of Service Edit: ClinicalCMS Policy

MUE for J9271 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 J9271 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 J9271 against another code to see whether a given pair bundles, which code is paid and whether a modifier can separate them.

J9271 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 J9271 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, J9271 carries status indicator K and is assigned to APC 1490, with a published national unadjusted payment of $62.253. Status K means the drug is paid separately under OPPS at the ASP-based rate rather than packaged into the procedure.

Ambulatory surgical center (ASC) payment

In the October 2026 ASC Addendum BB (covered ancillary services), J9271 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 $62.25 per 1 MG, paid only when the drug is furnished integral to a covered surgical procedure.

Common denials for J9271 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

For teams evaluating QuickIntell software

Evaluate a coding workflow for J9271

Use the unit, NDC and edit questions in this reference to scope a QuickCode evaluation for qualified coder review, documentation clarification and the billing handoff. Confirm supported code sets, data inputs and reviewer responsibilities; the reference tables do not establish that a particular automated check or payer integration is available.

Explore QuickCodeExplore QuickRCM
Book a software demoAsk about a software workflow

Optional software evaluation, not payer support or help with an individual claim. For coverage or payment decisions, use the official sources on this page. Do not include patient information in a demo booking or inquiry.

In QuickIntell research

Frequently asked questions — HCPCS J9271

What does HCPCS code J9271 describe?

J9271 is defined by CMS as "Injection, pembrolizumab, 1 mg". Each billing unit represents 1 MG, so the units reported on the claim must equal the dose administered divided by that unit.

Is J9271 a CPT code?

No. J9271 is a HCPCS Level II code, the letter-plus-four-digit set CMS maintains for drugs such as pembrolizumab (Keytruda); CPT codes are five-character codes maintained by the AMA. On a Part B claim J9271 reports the drug itself in 1 mg units, and the administration is billed on its own line.

What is the Medicare reimbursement for J9271 in October 2026?

The ASP-based payment limit is $62.253 per 1 MG, with 20% beneficiary coinsurance. The July 2026 limit was $60.645. Commercial payers use their own fee schedules.

How many units of J9271 can be billed per day?

The practitioner Medically Unlikely Edit is 400 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.

Which NDCs map to J9271?

The October 2026 ASP crosswalk lists 2 NDCs from 1 labeler: Keytruda (Merck Sharp & Dohme LLC). For example NDC 00006-3026-02 (package size 4) equals 100 billing units of J9271.

Does J9271 have NCCI bundling edits?

No active practitioner PTP pairs list J9271 as a column-1 or column-2 code in the v323r0 release.

J9271 vs J9277: what is the difference?

Both are HCPCS Level II codes whose descriptor names pembrolizumab. What sets J9277 apart: Keytruda Qlex. J9271 is billed per 1 mg, limit $62.253, MUE 400; J9277 is billed per 1 mg, limit $32.307. 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.