J9358 HCPCS code: Injection, fam-trastuzumab deruxtecan-nxki, 1 mg
J9358 is the HCPCS Level II code for injection, fam-trastuzumab deruxtecan-nxki, 1 mg. In 2024 Medicare paid an average of $21.26 per service for J9358 across 8,036,383 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 1000 per day on DME suppliers. Medicare volume rose 103% from 2022 to 2024 (3,955,843 to 8,036,383 services). In 2024, about 2,789 clinicians billed Medicare for J9358 for 3,150 beneficiaries; California, Texas, Florida accounted for 31% 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 | 2020-07-01 |
| Last action effective | 2020-07-01 |
Who bills J9358 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 2,789 |
| Medicare beneficiaries | 3,150 |
| States with claims | 40 |
| Share of services in top 3 states (California, Texas, Florida) | 31% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9358, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 3,955,843 | 1,851 | $24.22 | $19.33 |
| 2023 | 6,954,318 | 2,769 | $25.20 | $20.07 |
| 2024 | 8,036,383 | 3,150 | $26.68 | $21.26 |
States with the most J9358 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 1,011,498 | $21.37 |
| Texas | 744,761 | $21.51 |
| Florida | 724,067 | $20.97 |
| Illinois | 408,847 | $21.24 |
| Maryland | 360,544 | $21.25 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 1000 | CMS Policy |
| outpatient hospital claims | 1000 | CMS Policy |
| practitioner claims | 1000 | CMS Policy |
What changed for J9358
- 2020-07-01: J9358 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 J9358?
J9358 is the HCPCS Level II code for injection, fam-trastuzumab deruxtecan-nxki, 1 mg. Short descriptor: "Inj fam-trastu deru-nxki 1mg".
How much does Medicare pay for J9358?
In 2024, the average Medicare payment was $21.26 per service (average allowed $26.68).
Does Medicare cover J9358?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9358 can be billed per day?
1000 on DME suppliers; 1000 on outpatient hospital claims; 1000 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
Building a device that would bill under a code like this? Caduvo matches a device description to HCPCS/CPT codes, Medicare coverage and payment, and the FDA pathway in one report.
Next steps
- Run a reimbursement report for a device billed under J9358
- Watch J9358 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9358
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.