HCPCS code J9264: Paclitaxel albumin-bound, per 1 mg2026 Medicare rate & RVUs in Guam
Reports albumin-bound paclitaxel administered for selected cancers, with each HCPCS unit representing 1 mg of the drug.
CMS doesn’t publish an office rate for J9264 in Guam.
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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What J9264 covers
J9264 identifies paclitaxel formulated as protein-bound particles, commonly known by the brand name Abraxane. Oncology clinicians administer it by intravenous infusion for cancers including breast cancer, non-small cell lung cancer, and pancreatic adenocarcinoma. Treatment regimens may pair it with carboplatin for lung cancer or gemcitabine for pancreatic cancer.
CMS excludes J9264 from the physician fee schedule under status E. When Medicare covers the drug, payment is made under another payment method; CMS identifies it as a Part B drug generally priced from its quarterly Average Sales Price drug files when covered. Coverage is left to the Medicare contractor’s judgment. Each HCPCS unit represents 1 mg of paclitaxel, so units reflect the amount administered. Use J9264 for the albumin-bound formulation rather than conventional paclitaxel.
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.
J9264 in Hawaii, Guam, HI
| Payment locality | Office | Facility |
|---|---|---|
| Hawaii, Guam, HI | Unavailable | Unavailable |
How the J9264 rate is calculated
Each of J9264’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 · J9264
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 J9264
J9264 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 · J9264
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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J9264 isn’t priced in this setting.
J9264 compared with similar codes
Compare codes · National
J9264 vs J9267 vs J9201: Medicare rates
How to choose
- J9267Paclitaxel injectionPer 1 mg
- J9264 is for albumin-bound paclitaxel; J9267 is for conventional paclitaxel. Select the code for the formulation administered.
- J9201Gemcitabine injectionPer 200 mg
- J9201 identifies gemcitabine, a distinct drug that may be used in a pancreatic cancer regimen with J9264. It is not another code for paclitaxel.
J9264 billing questions
How many units should be reported?
Each unit represents 1 mg of paclitaxel. Calculate units from the amount administered.
When should J9264 be used instead of J9267?
Use J9264 for the albumin-bound paclitaxel formulation. J9267 identifies conventional paclitaxel.
Is J9264 paid under the physician fee schedule?
No. CMS assigns status E, excluding it from the physician fee schedule. When Medicare covers it, payment is under another method.
How does Medicare price the drug when covered?
CMS identifies it as a Part B drug generally priced from its quarterly Average Sales Price drug files when covered. Coverage is left to the Medicare contractor’s judgment.
Which drugs may be used with J9264 in a cancer regimen?
Carboplatin may be paired with it in non-small cell lung cancer treatment, and gemcitabine may be paired with it for pancreatic adenocarcinoma.
What should the record support?
Documentation should identify the albumin-bound product and the amount administered so the reported units reflect the 1 mg unit basis.
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.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
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