HCPCS code J9042: Brentuximab vedotin, per 1 mg2026 Medicare rate & RVUs in Massachusetts
J9042 identifies brentuximab vedotin, an intravenous antineoplastic drug reported by oncology practices for each 1 mg administered.
CMS doesn’t publish an office rate for J9042 in Massachusetts.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
What J9042 covers
J9042 identifies brentuximab vedotin, an antibody-drug conjugate given by intravenous infusion. Oncology practices and hospital outpatient departments report the drug when administering it for conditions such as Hodgkin lymphoma, systemic anaplastic large cell lymphoma, or other CD30-positive lymphomas. The drug is used in treatment plans that vary by diagnosis and clinical circumstances; the code identifies the drug, not the infusion service.
CMS assigns J9042 physician fee schedule status E, excluding it from the physician fee schedule. When Medicare covers the drug, it generally pays through the Part B drug method using CMS quarterly Average Sales Price pricing files; coverage is left to the Medicare contractor’s judgment. Report one unit for each 1 mg administered. Report the infusion administration separately when applicable, using the code that describes the service performed.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where J9042 pays more and less in Massachusetts
| Payment locality | Office | Facility |
|---|---|---|
| Metropolitan Boston, MA | Unavailable | Unavailable |
| Rest of Massachusetts | Unavailable | Unavailable |
How the J9042 rate is calculated
Each of J9042’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · J9042
RVUs × geographic indexes × conversion factor
Work0.00
0.00 RVUs× 1.000 GPCI
Practice expense0.00
0.00 RVUs× 1.000 GPCI
Malpractice0.00
0.00 RVUs× 1.000 GPCI
Adjusted RVUs
0.0000
Conversion factor
$33.4009
Medicare rate
$0.00
Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.
Payment rules and modifiers for J9042
J9042 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.
Place of service · J9042
Which rate does Medicare pay?
The POS code on the claim line (CMS-1500 box 24B).
POS 11 · non-facility rate · national
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J9042 isn’t priced in this setting.
J9042 compared with similar codes
Compare codes · National
J9042 vs J9041 vs J9039: Medicare rates
How to choose
J9042 billing questions
What drug does J9042 identify?
It identifies brentuximab vedotin, an intravenous antineoplastic drug. It is not a general code for lymphoma drugs.
How many units should be reported?
Each unit represents 1 mg of brentuximab vedotin administered. Calculate units from the administered dose in milligrams.
Does J9042 include the infusion service?
No. J9042 identifies the drug; report the applicable infusion administration service separately when performed.
How does Medicare treat J9042?
CMS excludes it from the physician fee schedule with status E. When covered, it generally uses the Part B drug payment method based on quarterly ASP pricing files, and coverage is left to the Medicare contractor.
How is J9042 different from J9041?
J9042 identifies brentuximab vedotin, while J9041 identifies bortezomib. They are different drugs and their codes are not interchangeable.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
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