J9395 HCPCS code: Injection, fulvestrant, 25 mg
J9395 is the HCPCS Level II code for injection, fulvestrant, 25 mg. In 2024 Medicare paid an average of $6.16 per service for J9395 across 1,108,110 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 15% from 2022 to 2024 (1,301,177 to 1,108,110 services). In 2024, about 3,903 clinicians billed Medicare for J9395 for 7,481 beneficiaries; Florida, California, 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 | O1E — Other drugs |
| Added | 2004-01-01 |
| Last action effective | 2004-01-01 |
Who bills J9395 (2024)
| Measure | Value |
|---|---|
| Clinicians billing (by place of service) | 3,903 |
| Medicare beneficiaries | 7,481 |
| States with claims | 44 |
| Share of services in top 3 states (Florida, California, Texas) | 35% |
Counts only. Supplier and clinician names, contact lists and state-by-state detail are in Caduvo.
Medicare utilization for J9395, 2022–2024
| Year | Services | Beneficiaries | Avg. allowed | Avg. paid |
|---|---|---|---|---|
| 2022 | 1,301,177 | 8,498 | $12.82 | $9.99 |
| 2023 | 1,080,133 | 7,312 | $10.36 | $8.06 |
| 2024 | 1,108,110 | 7,481 | $7.99 | $6.16 |
States with the most J9395 services (2024)
| State | Services | Avg. paid |
|---|---|---|
| Florida | 150,100 | $6.26 |
| California | 138,491 | $6.15 |
| Texas | 99,342 | $6.15 |
| Illinois | 55,160 | $6.19 |
| Maryland | 46,614 | $6.11 |
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 J9395
- 2004-01-01: J9395 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 J9395?
J9395 is the HCPCS Level II code for injection, fulvestrant, 25 mg. Short descriptor: "Injection, fulvestrant".
How much does Medicare pay for J9395?
In 2024, the average Medicare payment was $6.16 per service (average allowed $7.99).
Does Medicare cover J9395?
Coverage code C — Carrier judgment. Coverage is decided by the Medicare contractor (MAC) case by case.
How many units of J9395 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
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Next steps
- Run a reimbursement report for a device billed under J9395
- Watch J9395 for fee, coverage and descriptor changes
- Build a full Medicare revenue model for J9395
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.