J9394 HCPCS code: Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg
J9394 is the HCPCS Level II code for injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg. In 2024 Medicare paid an average of $26.74 per service for J9394 across 49,899 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 20 per day on DME suppliers. Medicare volume fell 47% from 2023 to 2024 (93,517 to 49,899 services). In 2024, about 403 clinicians billed Medicare for J9394 for 700 beneficiaries; California, Virginia, Oklahoma accounted for 64% 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 | 2023-01-01 |
| Last action effective | 2023-01-01 |
Who bills J9394 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 403 |
| Medicare beneficiaries | 700 |
| States with claims | 17 |
| Share of services in top 3 states (California, Virginia, Oklahoma) | 64% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9394, 2023–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2023 | 93,517 | 1,023 | $16.21 | $12.70 |
| 2024 | 49,899 | 700 | $31.32 | $26.74 |
States with the most J9394 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| California | 19,662 | $28.84 |
| Virginia | 6,820 | $25.39 |
| Oklahoma | 3,180 | $20.86 |
| Iowa | 2,780 | $22.34 |
| Texas | 2,230 | $23.23 |
NCCI unit limits (MUE)
| Claim type | Max units per day | Rationale |
|---|---|---|
| DME suppliers | 20 | Prescribing Information |
| outpatient hospital claims | 20 | Prescribing Information |
| practitioner claims | 20 | Prescribing Information |
What changed for J9394
- 2023-01-01: J9394 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 J9394?
J9394 is the HCPCS Level II code for injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg. Short descriptor: "Inj, fulvestrant (fresenius)".
How much does Medicare pay for J9394?
In 2024, the average Medicare payment was $26.74 per service (average allowed $31.32).
Does Medicare cover J9394?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9394 can be billed per day?
20 on DME suppliers; 20 on outpatient hospital claims; 20 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 J9394
- Watch J9394 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9394
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.