HCPCS Code J9264: Injection, Paclitaxel Protein-Bound Particles, 1 mg

## **What is the HCPCS code J9264 for?** The HCPCS code J9264 is a J code, and one of many that designate the provision of an injected medicine. For J9246, what is being designated is the provision of an injection of paclitaxel protein-bound particles (sometimes called protein-bound paclitaxel), specifically every 1 mg dose. This is commonly known as an Abraxane injection. This is a chemotherapy drug, and its purpose is to inhibit the growth and multiplication of cancer cells (especially metastatic diseases), as well as shrink and eliminate them to boost the survival rate of patients. The types of cancers this treats include non-small cell lung cancer, pancreatic cancer, metastatic breast cancer, gastric cancer, endometrial carcinoma, squamous cell carcinoma, cutaneous melanoma, and bladder cancer. It is often the choice after failure of combination chemotherapy for metastatic diseases or relapses within six months of adjuvant chemotherapy. It's also important that prior therapies have included anthracycline unless clinically contraindicated. It can also be used in combination with other medicines, such as carboplatin for non-small cell lung cancer, or gemcitabine for metastatic adenocarcinoma of the pancreas.

## **Documentation requirements for J9264** As with any HCPCS code, you'll need to prepare documentation that satisfies your insurer's coding practice requirements, guidelines, related policy articles, and local coverage determinations to avoid claim rejections. Here are examples of what you need: - The full name of the patient - The full names and credentials of the healthcare professionals handling the patient - The name, address, and type of facility where the injection was administered - The relevant information related to your patient's medical record and current condition to justify medical necessity and any one of the following indications: pancreatic cancer, metastatic breast cancer, gastric cancer, endometrial carcinoma, pancreatic adenocarcinoma, squamous cell carcinoma, etc. - Physician's order - Documentation of prior therapies and proof that they didn't work or were not as effective as projected - Drug information (e.g., drug name, total dosage administered, route of administration, lot number, manufacturer, National Drug Code, expiration date, etc.) - Infusion start and stop times - Imaging tests showing the size and location of malignant neoplasms, especially if they're present in overlapping sites

## **Billing requirements for J9264** Besides the documentation requirements above, it's important that you take note of the following: - 1 mg = 1 unit of service (e.g., 5 mg = 5 units of service) - Please use the relevant ICD codes appropriate for your patient's condition (it would be best to use specific codes, and avoid ones that mention unspecified site unless you really have to/there's no other choice) - Use appropriate CPT codes (e.g., 96413, 96415) - This is covered under Medicare Part B for FDA-approved indications and medically accepted off-label uses

## **Other similar codes** - **J9255** - Injection, methotrexate (accord), not therapeutically equivalent to j9260, 50 mg - **J9267** - Injection, paclitaxel, 1 mg - **J9043** - Injection, cabazitaxel, 1 mg - **J9171** - Injection, docetaxel, 1 mg - **J9306** - Injection, pertuzumab, 1 mg

Frequently asked questions

This is a chemotherapy drug, so common side effects include hair loss, vomiting, nausea, fatigue, low blood cell counts, and peripheral neuropathy. The serious albeit rare ones that you need to look out for are severe hypersensitivity reactions/allergic reactions, heart problems, bone marrow suppression, sensory neurotoxicity, and mucositis, and infections due to low white blood cell counts. You must closely monitor patients for any of these.

Using other chemotherapy drugs is viable. Other treatments include radiation therapy, targeted therapy, immunotherapy, curative surgery, and surgical removal of tumors.

It can take up to an hour since it's an IV injection.