HCPCS
J9264
1 mg = 1 unit
Phase 1
Identify what you're billing
Confirm Abraxane (J9264) vs paclitaxel (J9267) and the correct regimen first.
Paclitaxel class — J9264 (Abraxane) vs J9267 (paclitaxel) CMS HCPCS verified May 2026
Same active ingredient, two different products. The biller distinction matters for both claim coding and chair time.
Paclitaxel comes in two completely separate billable formulations: Abraxane (paclitaxel protein-bound, nab-paclitaxel, J9264) and conventional paclitaxel (solvent-based with Cremophor EL, J9267, available generically from multiple manufacturers). They share the active drug but are clinically and operationally distinct — you cannot substitute one for the other on the claim form.
| Abraxane (J9264) | Paclitaxel (J9267) | |
|---|---|---|
| HCPCS | J9264 — "Inj, paclitaxel protein-bound, 1 mg" | J9267 — "Injection, paclitaxel, 1 mg" |
| Formulation | Albumin-bound nanoparticles (nab-paclitaxel) | Solvent-based (Cremophor EL + ethanol) |
| Premedication for hypersensitivity | Not required | Required — dexamethasone + diphenhydramine + H2 blocker |
| Breast cancer dose | 260 mg/m² q3w | 175 mg/m² q3w (or 80 mg/m² weekly) |
| Infusion duration | 30 minutes | 3 hours (q3w) or 1 hour (weekly) |
| Vial | 100 mg lyophilized SDV | 30 / 100 / 300 mg multi-dose vials (concentration 6 mg/mL) |
| Manufacturer | Bristol Myers Squibb (Celgene) | Multiple generic manufacturers |
| ASP per mg (Q2 2026) | $6.020 | ~$0.20–$0.40 (varies; generic) |
| Approved indications | Breast, NSCLC (combo), pancreatic adeno (combo) | Breast, NSCLC, ovarian, AIDS-KS, others |
| In-line filter required | Do not use in-line filter | Use 0.22 µm in-line filter |
Operational difference for the infusion suite: No premed regimen for J9264 means no extra
chair time, no premed drug claim lines, and no first-infusion observation extension. This is why some
practices route patients to Abraxane despite the higher per-mg drug cost — chair-time throughput
offsets material cost. Document medical-necessity rationale (e.g., prior taxane hypersensitivity, prior
anthracycline failure) for the J9264 PA.
Common error: Submitting J9267 units when Abraxane was actually administered (or vice
versa). The two products cannot be substituted at the bedside. Reconcile chemo order, MAR, and pharmacy
dispense record before posting the claim.
Dosing & unit math FDA label verified May 2026
From the FDA-approved Abraxane prescribing information (NDA 21-660). All three regimens are BSA-based.
Multi-indication dosing matrix
| Indication | Abraxane dose | Schedule | Combo agent |
|---|---|---|---|
| Metastatic breast cancer (post-anthracycline failure) | 260 mg/m² | IV q3wk (every 21 days) | Monotherapy |
| Locally advanced or metastatic NSCLC (1L) | 100 mg/m² | IV Days 1, 8, 15 of 21-day cycles | + carboplatin AUC 6 IV Day 1 |
| Metastatic pancreatic adenocarcinoma (1L) | 125 mg/m² | IV Days 1, 8, 15 of 28-day cycles | + gemcitabine 1,000 mg/m² IV (after Abraxane) |
Worked example — metastatic breast (BSA 1.7 m², 260 mg/m²)
# Calculate dose
Dose: 260 mg/m² × 1.7 m² = 442 mg
Vials needed: 5 × 100 mg = 500 mg drawn
Discarded: 500 − 442 = 58 mg (single-dose vial waste)
# Drug claim lines
Line 1 (administered): J9264 · 442 units · modifier JZ-style (no JZ when JW present)
Line 2 (waste): J9264 · 58 units · modifier JW
# Admin claim line
96413 (chemo IV, 30-min infusion)
# Drug reimbursement (Q2 2026)
Total: 500 units × $6.020 = $3,010.00 (administered + waste, both reimbursable)
Dose: 260 mg/m² × 1.7 m² = 442 mg
Vials needed: 5 × 100 mg = 500 mg drawn
Discarded: 500 − 442 = 58 mg (single-dose vial waste)
# Drug claim lines
Line 1 (administered): J9264 · 442 units · modifier JZ-style (no JZ when JW present)
Line 2 (waste): J9264 · 58 units · modifier JW
# Admin claim line
96413 (chemo IV, 30-min infusion)
# Drug reimbursement (Q2 2026)
Total: 500 units × $6.020 = $3,010.00 (administered + waste, both reimbursable)
Worked example — pancreatic combo (BSA 1.8 m², 125 mg/m²)
# Calculate dose
Abraxane: 125 mg/m² × 1.8 m² = 225 mg (J9264, 225 units)
Vials needed: 3 × 100 mg = 300 mg drawn; discard 75 mg (JW)
Gemcitabine: 1,000 mg/m² × 1.8 m² = 1,800 mg (J9201, separate claim line)
# Schedule (28-day cycle)
Days 1, 8, 15: Abraxane 225 mg + gemcitabine 1,800 mg
Day 22: rest
# Annual exposure (continuous treatment, ~13 cycles)
Abraxane infusions: 3 × 13 = 39 doses/year
Abraxane: 125 mg/m² × 1.8 m² = 225 mg (J9264, 225 units)
Vials needed: 3 × 100 mg = 300 mg drawn; discard 75 mg (JW)
Gemcitabine: 1,000 mg/m² × 1.8 m² = 1,800 mg (J9201, separate claim line)
# Schedule (28-day cycle)
Days 1, 8, 15: Abraxane 225 mg + gemcitabine 1,800 mg
Day 22: rest
# Annual exposure (continuous treatment, ~13 cycles)
Abraxane infusions: 3 × 13 = 39 doses/year
No premedication routinely required
Per FDA label, Abraxane does not require premedication for hypersensitivity. The albumin-bound formulation eliminates Cremophor EL, which is the solvent in J9267 paclitaxel responsible for severe hypersensitivity reactions. Hypersensitivity reactions are still possible (rare) and should be managed per label if they occur. Do not bill premed drug claim lines for J9264.
NDC reference FDA NDC Directory verified May 2026
| NDC (10/11-digit) | Package | Use |
|---|---|---|
68817-134-50 / 68817-0134-50 |
100 mg lyophilized single-dose vial — 1 vial per carton | Standard dispensing unit; combine vials to reach BSA-calculated dose |
Use carton-level NDC, not vial-level. Payers expect the 11-digit NDC with N4 qualifier in
24A shaded area. Vial-level NDC variants will trigger denial. Reconstitute with 20 mL 0.9% NaCl per vial
to a 5 mg/mL suspension. Do not shake.
Single-source product: Unlike conventional paclitaxel (J9267), Abraxane has no generic
equivalent — BMS/Celgene is the sole manufacturer. There is no nab-paclitaxel biosimilar or
therapeutic equivalent in the U.S. as of May 2026.
Phase 2
Code the claim
Chemotherapy admin codes apply. JW for waste is the rule, not the exception.
Administration codes CPT verified May 2026
Abraxane is a true cytotoxic chemotherapy. Use chemo admin codes, not therapeutic infusion codes.
| Code | Description | When to use |
|---|---|---|
96413 |
Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug | Primary code for Abraxane. 30-min standard infusion fits within 1-hour window. Bill once per encounter as the initial chemo agent. |
96415 |
Chemotherapy administration, IV infusion; each additional hour (List separately) | Rarely needed for Abraxane itself (30 min). Use when combo regimen extends total chair time beyond 1 hour. |
96417 |
Chemo IV infusion, each additional sequential infusion (different drug) | For the second chemo agent in a combo regimen (e.g., gemcitabine after Abraxane in pancreatic). List separately from 96413. |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | NOT appropriate for Abraxane. Cytotoxic chemotherapy must use chemo admin codes per AMA CPT guidelines. |
Combo regimen sequencing: In NSCLC and pancreatic regimens, Abraxane is typically infused
first followed by carboplatin or gemcitabine. Bill 96413 for Abraxane (initial chemo), then 96417 for the
sequential second chemo agent. Add 96415 for any additional hour beyond the initial 60 minutes.
Modifiers CMS verified May 2026
JW — required on virtually every Abraxane claim
JW reports the discarded portion of a single-dose vial. Because Abraxane is BSA-dosed and supplied only in 100 mg single-dose vials, partial-vial waste occurs on virtually every dose unless the calculated dose lands on an exact 100 mg multiple. JW applies to virtually every J9264 claim. Bill the administered units on the primary line and the wasted units on a separate line with the JW modifier.
JZ — only when no waste
JZ applies only in the unusual case where the calculated dose equals an exact 100 mg multiple (e.g., a patient with BSA exactly 1.92 m² on the 260 mg/m² breast regimen yields 500 mg = 5 vials, no waste). One of JZ or JW must be on every J9264 claim per CMS's July 2023 single-dose container policy.
Common error: Failing to bill the JW waste line. CMS audits routinely catch this —
the wasted drug is reimbursable but must be reported on a separate line. Both administered and discarded
units pay at ASP+6%.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the infusion. Routine pre-infusion clinical assessment is bundled into the chemo admin code.
340B modifiers (JG, TB)
For 340B-acquired Abraxane, follow your MAC's current 340B modifier policy. Hospital outpatient departments billing under OPPS are subject to specific 340B reporting requirements; office-based 340B reporting varies by MAC.
ICD-10-CM by indication FY2026 verified May 2026
Three FDA-approved indications. Use the most specific code supported by encounter documentation; pair with secondary metastatic codes (C77–C79) where applicable.
| Indication | ICD-10 family | Notes |
|---|---|---|
| Metastatic breast cancer (post-anthracycline) | C50.x | Site/laterality 4th & 5th characters; document prior anthracycline failure in chart for PA |
| NSCLC — upper lobe | C34.10 / C34.11 / C34.12 | Unspec / right / left upper lobe |
| NSCLC — middle lobe | C34.2 | Right middle lobe (no left middle lobe) |
| NSCLC — lower lobe | C34.30 / C34.31 / C34.32 | Unspec / right / left lower lobe |
| NSCLC — main bronchus / overlapping / unspec | C34.0x / C34.8x / C34.9x | Use when histology is non-small-cell but lobe documentation is incomplete |
| Pancreatic adenocarcinoma — head | C25.0 | Most common location |
| Pancreatic adenocarcinoma — body | C25.1 | |
| Pancreatic adenocarcinoma — tail | C25.2 | |
| Pancreatic adenocarcinoma — overlapping / NOS | C25.8 / C25.9 | Use when site documentation is incomplete |
| Secondary malignancy (paired) | C77–C79 | Add for nodal (C77.x), respiratory/digestive (C78.x), or other site (C79.x) metastases |
Indication-specific PA criteria are the norm. UnitedHealthcare and most major commercial
payers require prior anthracycline failure documentation for the breast cancer indication, and concurrent
PA on the combo agent (carboplatin for NSCLC; gemcitabine for pancreatic). The ICD-10 code alone is not
sufficient for approval.
Site of care & place of service Verified May 2026
Abraxane is typically administered in oncology offices, ambulatory infusion centers, and hospital outpatient departments. The 30-minute infusion fits cleanly into office and AIC chair-time slots, and the no-premed advantage shortens total visit time relative to J9267 paclitaxel. Major commercial payers run site-of-care UM for high-cost oncology drugs and increasingly steer chemo out of HOPD into office or AIC settings.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Physician oncology office | 11 | CMS-1500 / 837P | Preferred by commercial UM |
| Ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Preferred by commercial UM |
| Oncology ASC | 24 | CMS-1500 / 837P | Acceptable |
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Disfavored after first cycles by commercial site-of-care UM |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Disfavored |
| Patient home | 12 | CMS-1500 (with home infusion) | Rare for cytotoxic chemo |
Chair-time advantage: Abraxane's 30-minute infusion plus zero premedication regimen makes
it materially faster per-visit than J9267 paclitaxel (3-hour infusion + 30-60 min premed). For practices
capacity-constrained by chair time, the throughput offset can outweigh the higher per-mg drug cost of
J9264.
Claim form field mapping BMS Access Support 2026
From BMS Access Support Abraxane HCP coding & coverage materials.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + 68817-0134-50 + ML + total volume drawn (e.g., 100 mL for 500 mg drawn) |
| HCPCS J9264 + JW (waste line) | 24D (waste line) | Wasted units only; almost always present for BSA dosing |
| HCPCS J9264 (administered line) | 24D (drug line) | Administered units; this is the larger line |
| Drug units | 24G | Actual mg administered (e.g., 442 for 260 mg/m² × 1.7 BSA) |
| CPT 96413 (admin line) | 24D (admin line) | 30-min chemo IV infusion |
| CPT 96417 (additional sequential chemo) | 24D | For second chemo agent in combo (gemcitabine, carboplatin) |
| ICD-10 | 21 | Indication-specific (see ICD-10 table) |
| PA number | 23 | Required by all major commercial payers |
Phase 3
Get paid
PA + indication-specific docs (e.g., prior anthracycline failure) are the rule. Combo agent has its own PA.
Payer policy snapshot Reviewed May 2026
All major payers require PA. Indication-specific documentation requirements vary; combo agents have their own PA.
| Payer | PA? | Indication-specific requirements | Site-of-care UM |
|---|---|---|---|
| UnitedHealthcare Oncology Med Coverage Policy |
Yes | Breast: documented prior anthracycline failure or contraindication. NSCLC: 1L combo with carboplatin. Pancreatic: 1L combo with gemcitabine. Concurrent PA on combo agents. | Aggressive: chemo steered out of HOPD via Optum-managed program |
| Aetna CPB + Medical Drug policies |
Yes | Aligned with NCCN and FDA label; documentation of disease stage and prior therapy required | Yes (separate Site-of-Care policy) |
| BCBS plans Vary by plan |
Yes | Generally aligned with NCCN guidelines + FDA label requirements | Plan-specific; most have oncology site-of-care steering |
Step therapy
For metastatic breast cancer, prior anthracycline therapy failure or contraindication is essentially a gating requirement — UHC and Aetna both ask for documentation in the PA submission. For NSCLC and pancreatic, Abraxane is approved as 1L combo therapy and step through other 1L regimens is generally not required, but verify per payer. Some plans prefer J9267 paclitaxel as the step before J9264 for breast cancer; document hypersensitivity history or anthracycline failure to overcome.
NCCN compendium support
Abraxane is included in NCCN Breast, NSCLC, and Pancreatic Adenocarcinoma guidelines as a Category 1 or 2A regimen for the FDA-labeled indications. Off-label NCCN-supported uses (e.g., melanoma combo) may be coverable under compendium-based PA but require additional documentation.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J9264
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$6.020
per mg / per unit
442 mg breast dose
$2,660.84
260 mg/m² × 1.7 BSA
225 mg pancreatic dose
$1,354.50
125 mg/m² × 1.8 BSA
Wasted drug is reimbursable. Bill the JW line for the discarded portion — both
administered and discarded units pay at ASP+6%. For a 442 mg dose drawn from 5 × 100 mg vials:
500 units total billed (442 administered + 58 waste) = $3,010.00 drug reimbursement before sequestration.
Sequestration: Approximately 2% reduction applies to actual paid amount, bringing
effective reimbursement to roughly ASP + 4.3% rather than ASP + 6%.
Coverage
No NCD specific to nab-paclitaxel. Coverage falls under MAC LCDs for chemotherapy + the generic drug coverage framework. All MACs cover J9264 for FDA-approved on-label indications with appropriate ICD-10 and clinical documentation. NCCN compendium support extends Medicare coverage to additional NCCN-listed regimens.
Code history
- J9264 — permanent code, "Injection, paclitaxel protein-bound particles, 1 mg"; pre-permanent-code period used unclassified J9999
Patient assistance — BMS Access Support BMS verified May 2026
- BMS Access Support: 1-800-861-0048 / bmsaccesssupport.com — benefits investigation, prior authorization assistance, appeal support
- Abraxane Co-Pay Assistance Program: commercial copay support; eligible commercially-insured patients pay as little as $5 for the first dose (excludes Medicare, Medicaid, federal program patients)
- BMS Patient Assistance Foundation: free product for uninsured / underinsured patients meeting income requirements (administered through the BMS Patient Assistance Program, Inc., a 501(c)(3))
- Foundations (Medicare patients): PAN Foundation, HealthWell Foundation, CancerCare Co-Payment Assistance — verify open oncology funds quarterly (breast, pancreatic, lung funds open and close throughout the year)
- Web: bmsaccesssupport.com
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance,
and OOP max? Run a CareCost Estimate — J9264 pre-loaded.
Phase 4
Fix problems
Missed JW, wrong HCPCS (J9264 vs J9267), and missing anthracycline documentation are the top three.
Peripheral neuropathy — cumulative & dose-limiting FDA label
Per FDA label: Peripheral neuropathy is cumulative and dose-limiting. Sensory neuropathy
of grade 3 or higher requires withholding Abraxane until improvement to grade 1 or baseline; resumption
is at a reduced dose. Severe (grade 3+) neuropathy reported in 8% of metastatic breast patients and up
to 17% of pancreatic combo patients in pivotal trials.
Documentation expectations
- Grade neuropathy at baseline (CTCAE v5.0) and at every cycle visit
- Document dose holds, reductions, and resolution to grade 1 or baseline before resuming
- Reduce dose per FDA label (e.g., 260 → 220 → 180 mg/m² for breast; analogous reductions for NSCLC/pancreatic regimens)
- Payer audits and PA renewals frequently request neuropathy monitoring evidence
Other FDA-label warnings & precautions
- Severe neutropenia: ANC <1,500 cells/µL contraindicates initiation or restart; monitor CBC frequently
- Sepsis: may be fatal; monitor for signs of infection particularly in pancreatic combo regimen with neutropenia or biliary obstruction
- Pneumonitis: permanently discontinue if confirmed
- Hypersensitivity reactions: rare (Cremophor EL-free formulation); manage per label if they occur
- Hepatic impairment: dose adjustment required for moderate-to-severe impairment; not recommended in severe hepatic impairment for breast indication
- Embryo-fetal toxicity: can cause fetal harm; counsel on contraception
Abraxane carries no FDA Boxed Warning — this is a notable difference from conventional paclitaxel (J9267), which carries a boxed warning for severe hypersensitivity reactions attributable to the Cremophor EL solvent.
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| JW waste line missing | Wasted units not reported on BSA-dosed claim | Add JW line for discarded units. Both administered and discarded units pay at ASP+6%. |
| Wrong HCPCS (J9267 instead of J9264) | nab-Paclitaxel billed under conventional paclitaxel code | Resubmit with J9264. Reconcile chemo order, MAR, and pharmacy dispense record before next claim. |
| Wrong admin code (96365) | Therapeutic IV billed instead of chemo IV | Resubmit with 96413. Abraxane is cytotoxic chemotherapy; chemo admin codes apply. |
| Anthracycline failure not documented (breast) | PA submitted without prior therapy history | Submit chart note documenting prior anthracycline regimen, response, and reason for discontinuation (toxicity or progression). |
| Combo agent PA missing (NSCLC/pancreas) | Concurrent PA on carboplatin or gemcitabine not in place | Submit combo agent PA in parallel with Abraxane PA. Most payers require both before approving the regimen. |
| Wrong NDC format (vial-level) | Vial NDC submitted instead of carton NDC with N4 qualifier | Use 11-digit carton NDC: 68817-0134-50 with N4 qualifier in 24A shaded area. |
| Site of care (HOPD) | HOPD administration on commercial plan with site-of-care UM | Move to office (POS 11) or AIC (POS 49). Submit medical necessity letter if HOPD required. |
| Premed drug claim line denied | Premedication billed for J9264 | Remove premed line. Abraxane does not require premedication; premed claims are not reimbursable for J9264. |
| Neuropathy monitoring not documented at PA renewal | Continuation PA submitted without grade-by-cycle neuropathy log | Submit chart documentation of CTCAE grade at each cycle, dose holds, and resumptions. |
Frequently asked questions
What is the HCPCS code for Abraxane?
Abraxane (paclitaxel protein-bound, nab-paclitaxel) is billed under HCPCS J9264 —
"Injection, paclitaxel protein-bound particles, 1 mg." Each milligram equals one billable unit. Abraxane
(J9264) is distinct from solvent-based paclitaxel (J9267) and the two are NOT interchangeable for billing
or clinical use.
How many units do I bill for an Abraxane dose?
Bill the actual mg administered. For metastatic breast at 260 mg/m² with BSA 1.7 m² that equals 442 mg = 442 units. For NSCLC at 100 mg/m² with BSA 1.7 m² that equals 170 mg = 170 units. For pancreatic at 125 mg/m² with BSA 1.7 m² that equals 213 mg = 213 units. Because vials are 100 mg single-dose and dosing is BSA-based, partial-vial waste is the norm — bill JW on a separate claim line for the discarded portion.
What administration CPT do I use for Abraxane?
CPT 96413 — "Chemotherapy administration, IV infusion technique; up to 1 hour, single
or initial substance/drug." Abraxane is true cytotoxic chemotherapy and the standard infusion is 30
minutes, fitting within the 1-hour 96413 window. For combo regimens (NSCLC + carboplatin, pancreatic +
gemcitabine), add 96417 for the sequential second chemo agent. Do NOT bill 96365.
Does Abraxane require premedication?
No. Abraxane is an albumin-bound nanoparticle formulation that does NOT contain Cremophor EL or polysorbate 80, the solvents in conventional paclitaxel (J9267) responsible for severe hypersensitivity reactions. Per FDA label, no routine premedication for hypersensitivity is required. This is a major operational difference from J9267 — no diphenhydramine/H2 blocker/dexamethasone premed regimen, no extended chair time. Hypersensitivity reactions still occur rarely and should be managed per label.
Do I bill JZ or JW for Abraxane?
Almost always JW. Vials are 100 mg single-dose and Abraxane is dosed by BSA, so partial-vial waste occurs on virtually every dose. Example: 442 mg dose uses five 100 mg vials (500 mg drawn) and discards 58 mg — bill 442 units of administered drug and 58 units on a JW line. JZ applies only when the dose lands exactly on a 100 mg multiple. One of JZ or JW must be on every J9264 claim per CMS's July 2023 single-dose container policy.
What is the Medicare reimbursement for J9264?
For Q2 2026, the Medicare Part B payment limit for J9264 is $6.020 per mg (ASP + 6%). A 442 mg breast cancer dose reimburses at approximately $2,660.84 (drug only, before sequestration). Wasted drug billed on the JW line is also reimbursable. Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.
How is Abraxane (J9264) different from paclitaxel (J9267)?
Same active ingredient (paclitaxel), entirely different formulation and billing. Abraxane (J9264) is albumin-bound nab-paclitaxel — Cremophor EL-free, no premedication required, dosed at higher mg/m² (260 mg/m² q3w for breast vs 175 mg/m² for J9267). Conventional paclitaxel (J9267) requires diphenhydramine + H2 blocker + dexamethasone premed for Cremophor EL hypersensitivity. The two products are NOT interchangeable. ASP per mg differs substantially. See the paclitaxel class comparison section for the full table.
What ICD-10 codes do I use for Abraxane?
Indication-specific. Metastatic breast cancer: C50.x (laterality + quadrant). Locally
advanced or metastatic NSCLC: C34.x (lobe-specific 4th character). Metastatic pancreatic
adenocarcinoma: C25.0 (head), C25.1 (body), C25.2 (tail),
C25.9 (NOS). Pair with secondary metastatic codes (C77–C79) where applicable. Most
payers also require documentation of prior anthracycline failure for the breast indication.
Is Abraxane used in combination with immune checkpoint inhibitors?
Yes — in metastatic triple-negative breast cancer (mTNBC), Abraxane has been studied in combination with PD-(L)1 inhibitors. Keytruda (J9271) is approved with chemotherapy (including nab-paclitaxel) for PD-L1+ mTNBC; Tecentriq (J9022) previously held an accelerated approval with Abraxane in PD-L1+ mTNBC (status has since changed; verify current label). Each agent bills under its own HCPCS with its own PA. See those drug pages for combo billing specifics.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- FDA — ABRAXANE prescribing information (NDA 21-660)
- DailyMed — ABRAXANE (paclitaxel protein-bound particles)
- BMS Access Support — Abraxane HCP coding & coverage
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J9264 reference
- NCCN Clinical Practice Guidelines in Oncology — Breast, NSCLC, Pancreatic Adenocarcinoma
- UnitedHealthcare — Oncology Medication Clinical Coverage Policy
- Aetna Clinical Policy Bulletins — Antineoplastic agents
- CMS HCPCS Level II Quarterly Updates
- FDA National Drug Code Directory
- CMS — JW/JZ modifier policy (CR 12056, eff. July 2023)
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules | Annual | Reviewed against CMS HCPCS quarterly files and AMA CPT releases. |
| NDC, dosing, FDA label, indication list | Event-driven | Tied to manufacturer document version + FDA label revision date. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS,
manufacturer, payer documents — all linked above). Editorial review in progress. Until that review is complete, treat this as a draft reference and verify each cited
source for high-stakes claims.
Change log
- — Initial publication. ASP data: Q2 2026. Manufacturer source: BMS Access Support 2026. Three approved indications (metastatic breast, NSCLC combo, pancreatic adeno combo). Paclitaxel class comparison vs J9267 included.
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list and dosing are verified against the current FDA label revision. We do not paraphrase from billing-software vendor blogs.