J9312 HCPCS code: Injection, rituximab, 10 mg
J9312 is the HCPCS Level II code for injection, rituximab, 10 mg. In 2024 Medicare paid an average of $59.94 per service for J9312 across 3,292,557 services. Its Medicare coverage code is D (Special coverage instructions apply): Medicare covers it when its national or local coverage criteria are met. The NCCI unit limit is 150 per day on outpatient hospital claims. Medicare volume fell 11% from 2022 to 2024 (3,689,666 to 3,292,557 services). In 2024, about 4,135 clinicians billed Medicare for J9312 for 12,326 beneficiaries; Texas, Florida, California accounted for 27% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | D — Special coverage instructions apply |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2019-01-01 |
| Last action effective | 2019-01-01 |
Who bills J9312 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 4,135 |
| Medicare beneficiaries | 12,326 |
| States with claims | 50 |
| Share of services in top 3 states (Texas, Florida, California) | 27% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9312, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,689,666 | 13,696 | $81.45 | $65.03 |
| 2023 | 3,399,795 | 12,859 | $77.83 | $61.99 |
| 2024 | 3,292,557 | 12,326 | $75.27 | $59.94 |
States with the most J9312 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 326,529 | $59.29 |
| Florida | 316,651 | $60.25 |
| California | 254,950 | $59.85 |
| New York | 168,485 | $60.16 |
| Pennsylvania | 138,590 | $61.17 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 150 | Prescribing Information |
| practitioner claims | 150 | Prescribing Information |
Medicare policy articles for this code
- A55639: Billing and Coding: Chemotherapy Agents for Non-Oncologic Conditions (WPS Insurance Corporation (MAC - Part A, MAC - Part B))
- A56380: Billing and Coding: Rituximab (Palmetto GBA (MAC - Part A, MAC - Part B))
- A57160: Billing and Coding: Immune Thrombocytopenia (ITP) Therapy (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A58582: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (CGS Administrators, LLC (MAC - Part A, MAC - Part B))
- A59101: Billing and Coding: Off-label Use of Rituximab and Rituximab Biosimilars (Wellpoint Federal (MAC - Part A, MAC - Part B))
Covered diagnoses (1,184 ICD-10-CM codes)
The diagnoses most often listed as covered in the policy articles above:
| ICD-10-CM | Diagnosis | Articles listing it |
|---|---|---|
| D69.3 | Immune thrombocytopenic purpura | 5 |
| D59.0 | Drug-induced autoimmune hemolytic anemia | 4 |
| D59.11 | Warm autoimmune hemolytic anemia | 4 |
| D59.12 | Cold autoimmune hemolytic anemia | 4 |
| D59.13 | Mixed type autoimmune hemolytic anemia | 4 |
| D69.41 | Evans syndrome | 4 |
| D89.811 | Chronic graft-versus-host disease | 4 |
| G35.A | Relapsing-remitting multiple sclerosis | 4 |
| G36.0 | Neuromyelitis optica [Devic] | 4 |
| G70.00 | Myasthenia gravis without (acute) exacerbation | 4 |
Showing 10 of 1,184. The full list, non-covered diagnoses and CSV export are in Caduvo.
What changed for J9312
- 2019-01-01: J9312 added to HCPCS Level II
- Next scheduled CMS quarterly update (HCPCS and DMEPOS fee schedule): 2027-01-01
Frequently asked questions
What is HCPCS code J9312?
J9312 is the HCPCS Level II code for injection, rituximab, 10 mg. Short descriptor: "Inj., rituximab, 10 mg".
How much does Medicare pay for J9312?
In 2024, the average Medicare payment was $59.94 per service (average allowed $75.27).
Does Medicare cover J9312?
Coverage code D — Special coverage instructions apply. Medicare covers it when its national or local coverage criteria are met.
Which diagnoses support coverage for J9312?
Medicare policy articles that cite J9312 list 1,184 covered ICD-10-CM diagnosis codes across 5 articles. The most cited include D69.3 (Immune thrombocytopenic purpura), D59.0 (Drug-induced autoimmune hemolytic anemia), D59.11 (Warm autoimmune hemolytic anemia). A listed diagnosis is necessary but not sufficient; the policy's other criteria still apply.
How many units of J9312 can be billed per day?
150 on outpatient hospital claims; 150 on practitioner claims (NCCI medically unlikely edits).
Related J93 codes
- J9300 — Injection, gemtuzumab ozogamicin, 5 mg
- J9301 — Injection, obinutuzumab, 10 mg
- J9302 — Injection, ofatumumab, 10 mg
- J9303 — Injection, panitumumab, 10 mg
- J9304 — Injection, pemetrexed (pemfexy), 10 mg
- J9305 — Injection, pemetrexed, not otherwise specified, 10 mg
- J9306 — Injection, pertuzumab, 1 mg
- J9307 — Injection, pralatrexate, 1 mg
- J9308 — Injection, ramucirumab, 5 mg
- J9309 — Injection, polatuzumab vedotin-piiq, 1 mg
- J9310 — Injection, rituximab, 100 mg
- J9311 — Injection, rituximab 10 mg and hyaluronidase
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Next steps
- Run a reimbursement report for a device billed under J9312
- Watch J9312 for fee, coverage and descriptor changes
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Sources: CMS HCPCS Level II release October 2025; CMS DMEPOS fee schedule; CMS NCCI MUE tables; CMS Medicare utilization (physician and DME supplier files); CMS Medicare Coverage Database articles. Fees are Medicare allowables, not commercial rates. Not billing or legal advice.