J9354 HCPCS code: Injection, ado-trastuzumab emtansine, 1 mg
J9354 is the HCPCS Level II code for injection, ado-trastuzumab emtansine, 1 mg. In 2024 Medicare paid an average of $30.40 per service for J9354 across 1,330,260 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 600 per day on outpatient hospital claims. Medicare volume fell 30% from 2022 to 2024 (1,913,451 to 1,330,260 services). In 2024, about 1,246 clinicians billed Medicare for J9354 for 812 beneficiaries; California, Florida, Texas accounted for 35% 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 | 2014-01-01 |
| Last action effective | 2014-01-01 |
Who bills J9354 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 1,246 |
| Medicare beneficiaries | 812 |
| States with claims | 27 |
| Share of services in top 3 states (California, Florida, Texas) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9354, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,913,451 | 1,090 | $33.90 | $27.06 |
| 2023 | 1,485,836 | 861 | $36.27 | $28.89 |
| 2024 | 1,330,260 | 812 | $38.17 | $30.40 |
States with the most J9354 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 165,792 | $30.47 |
| Florida | 157,628 | $30.32 |
| Texas | 108,282 | $30.61 |
| Maryland | 78,552 | $30.26 |
| Tennessee | 71,338 | $30.84 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 600 | Prescribing Information |
| practitioner claims | 600 | Prescribing Information |
What changed for J9354
- 2014-01-01: J9354 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 J9354?
J9354 is the HCPCS Level II code for injection, ado-trastuzumab emtansine, 1 mg. Short descriptor: "Inj, ado-trastuzumab emt 1mg".
How much does Medicare pay for J9354?
In 2024, the average Medicare payment was $30.40 per service (average allowed $38.17).
Does Medicare cover J9354?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9354 can be billed per day?
600 on outpatient hospital claims; 600 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 J9354
- Watch J9354 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9354
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.