HCPCS code J9271 — Inj pembrolizumab.
Status: Active.
Effective Jan 1, 2016.
Source: CMS HCPCS Level II.
J9271
ActiveInj pembrolizumab
Injection, pembrolizumab, 1 mg
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Jan 1, 2016
Code type:
alphanumeric
OPPS Status:
K
— Non-pass-through drugs and biologicals
OPPS APC:
1490
Drug class:
Anti-PD-1 Checkpoint Inhibitors
Medicare Part B utilization — 2023
Services billed
1,800,000
Beneficiaries
89,000
Medicare paid
$328,000,000
Avg per service
$227.78
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of J9271 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| DME Supplier | 0 |
| Outpatient Hospital | 400 |
| Practitioner Services | 400 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NDC Crosswalk
National Drug Codes (NDCs) mapped to this HCPCS code.
| NDC | Drug Name |
|---|---|
| 00006-3026-02 | Keytruda |
| 00006-3026-04 | Keytruda |