J9356 HCPCS code: Injection, trastuzumab, 10 mg and hyaluronidase-oysk
J9356 is the HCPCS Level II code for injection, trastuzumab, 10 mg and hyaluronidase-oysk. In 2024 Medicare paid an average of $50.91 per service for J9356 across 99,130 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 60 per day on outpatient hospital claims. Medicare volume rose 46% from 2022 to 2024 (67,880 to 99,130 services). In 2024, about 361 clinicians billed Medicare for J9356 for 214 beneficiaries; Texas, California, Michigan accounted for 62% 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 | 2019-07-01 |
| Last action effective | 2019-07-01 |
Who bills J9356 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 361 |
| Medicare beneficiaries | 214 |
| States with claims | 7 |
| Share of services in top 3 states (Texas, California, Michigan) | 62% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9356, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 67,880 | 142 | $68.59 | $54.76 |
| 2023 | 81,798 | 187 | $64.41 | $51.27 |
| 2024 | 99,130 | 214 | $63.99 | $50.91 |
States with the most J9356 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Texas | 16,440 | $50.94 |
| California | 10,803 | $50.98 |
| Michigan | 9,120 | $50.92 |
| Florida | 7,440 | $50.95 |
| Illinois | 5,640 | $50.63 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| outpatient hospital claims | 60 | Prescribing Information |
| practitioner claims | 60 | Prescribing Information |
What changed for J9356
- 2019-07-01: J9356 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 J9356?
J9356 is the HCPCS Level II code for injection, trastuzumab, 10 mg and hyaluronidase-oysk. Short descriptor: "Inj. herceptin hylecta, 10mg".
How much does Medicare pay for J9356?
In 2024, the average Medicare payment was $50.91 per service (average allowed $63.99).
Does Medicare cover J9356?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9356 can be billed per day?
60 on outpatient hospital claims; 60 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 J9356
- Watch J9356 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9356
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.