J9355 HCPCS code: Injection, trastuzumab, excludes biosimilar, 10 mg
J9355 is the HCPCS Level II code for injection, trastuzumab, excludes biosimilar, 10 mg. In 2024 Medicare paid an average of $60.59 per service for J9355 across 323,910 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 120 per day on outpatient hospital claims. Medicare volume fell 33% from 2022 to 2024 (483,191 to 323,910 services). In 2024, about 939 clinicians billed Medicare for J9355 for 826 beneficiaries; California, Kansas, Florida accounted for 36% 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 | O1E — Other drugs |
| Added | 2000-01-01 |
| Last action effective | 2019-07-01 |
Who bills J9355 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 939 |
| Medicare beneficiaries | 826 |
| States with claims | 23 |
| Share of services in top 3 states (California, Kansas, Florida) | 36% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9355, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 483,191 | 1,217 | $83.15 | $66.36 |
| 2023 | 343,017 | 913 | $76.95 | $61.28 |
| 2024 | 323,910 | 826 | $76.10 | $60.59 |
States with the most J9355 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 44,723 | $60.54 |
| Kansas | 31,940 | $62.03 |
| Florida | 25,919 | $60.21 |
| Tennessee | 20,515 | $62.00 |
| New York | 19,903 | $58.66 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 120 | Prescribing Information |
| practitioner claims | 120 | Prescribing Information |
What changed for J9355
- 2000-01-01: J9355 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 J9355?
J9355 is the HCPCS Level II code for injection, trastuzumab, excludes biosimilar, 10 mg. Short descriptor: "Inj trastuzumab excl biosimi".
How much does Medicare pay for J9355?
In 2024, the average Medicare payment was $60.59 per service (average allowed $76.10).
Does Medicare cover J9355?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9355 can be billed per day?
120 on outpatient hospital claims; 120 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 J9355
- Watch J9355 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9355
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.