J9316 HCPCS code: Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
J9316 is the HCPCS Level II code for injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg. In 2024 Medicare paid an average of $51.24 per service for J9316 across 920,608 services. Its Medicare coverage code is C (Carrier judgment): Coverage is decided by the Medicare contractor (MAC) case by case. The NCCI unit limit is 180 per day on outpatient hospital claims. Medicare volume rose 176% from 2022 to 2024 (333,114 to 920,608 services). In 2024, about 1,256 clinicians billed Medicare for J9316 for 1,090 beneficiaries; Texas, California, Florida accounted for 34% of services.
Code details
| Field | Value |
|---|---|
| Section | J codes — Drugs administered other than oral method |
| Coverage code | C — Carrier judgment |
| Pricing indicator | 51 — Drug or biological (priced per ASP/average sales price rules) |
| BETOS category | O1D — Chemotherapy |
| Added | 2021-01-01 |
| Last action effective | 2021-01-01 |
Who bills J9316 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,256 |
| Medicare beneficiaries | 1,090 |
| States with claims | 28 |
| Share of services in top 3 states (Texas, California, Florida) | 34% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9316, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 333,114 | 418 | $69.11 | $55.14 |
| 2023 | 596,470 | 763 | $66.18 | $52.72 |
| 2024 | 920,608 | 1,090 | $64.33 | $51.24 |
States with the most J9316 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 147,492 | $50.64 |
| California | 79,220 | $51.52 |
| Florida | 67,920 | $51.35 |
| Tennessee | 66,960 | $51.09 |
| Maryland | 65,941 | $51.35 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 180 | Prescribing Information |
| practitioner claims | 180 | Prescribing Information |
What changed for J9316
- 2021-01-01: J9316 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 J9316?
J9316 is the HCPCS Level II code for injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg. Short descriptor: "Pertuzu, trastuzu, 10 mg".
How much does Medicare pay for J9316?
In 2024, the average Medicare payment was $51.24 per service (average allowed $64.33).
Does Medicare cover J9316?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9316 can be billed per day?
180 on outpatient hospital claims; 180 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 J9316
- Watch J9316 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9316
Sources: CMS HCPCS Level II release October 2026; 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.