HCPCS J9271: what Medicare pays in 2026
Drug CMS description: Inj pembrolizumab
Medicare's Part B payment limit for J9271 from October 1 to December 31, 2026 is $62.253 per billing unit of 1 MG. Check the number of units on your bill: drug lines are billed in these units.
Medicare amounts for J9271 in 2026
- Hospital outpatient rate, national (APC 1490)
- $60.65
- Hospital outpatient status K
- separately paid drug
- Part B drug payment limit per 1 MG
- $62.253
Hospital outpatient rates are national figures before Medicare's wage adjustment, which moves about 60% of the rate up or down with local hospital wages.
What providers charged Medicare for J9271 in 2024
From CMS's national utilization file (the most recent full year published). The charge is the provider's list price, the same kind of figure an uninsured patient is usually billed.
| Setting | Units billed | Average charge | Medicare allowed | Charge vs allowed |
|---|---|---|---|---|
| In an office or other non-facility setting | 38,018,750 | $136.01 | $55.28 | 2.5× |