J9316
J9316 – Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg · NDC Crosswalk & Billing Units
HCPCS Level II J-code · Medicare Part B drug billing
J-code
● 2 NDCs crosswalked per 10 MG $59.895/unit ASP+6%
📋 J9316 summary
J9316 is a HCPCS Level II J-code used to bill pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg, billed per 10 MG. The number of billing units to report depends on the dose administered and the NDC/package billed — use the calculator below.
Brand names associated with J9316: Phesgo
Code J9316
Billing unit 10 MG Payment limit $59.895/unit NDC-Crosswalk 2
Quarter Q3 2026
RxCUI Atlas Trace the drug concept →
⚠ An NDC↔HCPCS crosswalk and a published payment limit do not guarantee payer coverage or payment. Always verify the current payer policy and claim format before billing.
🗂️ Key billing facts
HCPCS codeJ9316
DescriptorInjection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
Billing unit10 MG
Payment limit / unit$59.895
Est. ASP / unit$56.505 est.
Mapped NDCs2
Data periodQ3 2026
Last updated2026-08-20
💊 About Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Injection DRUG GUIDE
Phesgo (pertuzumab, trastuzumab, and hyaluronidase-zzxf) is used to treat HER2-positive breast cancer in adults.
It is given before surgery (neoadjuvant) or after surgery (adjuvant) for early-stage HER2-positive breast cancer, including locally advanced or inflammatory breast cancer, always in combination with chemotherapy.Phesgo is also used alongside docetaxel chemotherapy for HER2-positive metastatic breast cancer (cancer that has spread to other parts of the body) in adults who have not yet received anti-HER2 therapy or chemotherapy for their metastatic disease.
Patients must test positive for HER2 overexpression or gene amplification before starting treatment.
Clinical overview from our editorial drug guide for Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf Injection. For billing reference, see the sections above.
🧾 Billing & reimbursement HCPCS · CMS · EFF. Q3 2026
📅 Payment limits effective Q3 2026 — from the CMS Medicare Part B Payment Limit File (revised quarterly).
Medicare payment limit / unit
$59.895
Est. ASP / unit
$56.505 est.
Est. after 2% sequester
$58.697
HCPCS dosage
10 MG
The CMS payment limit is the Medicare Part B drug allowance (ASP + 6%, statutory). After the 2% federal sequester the effective payment is ≈ ASP + 4.3%; estimated ASP = payment limit ÷ 1.06. Source: CMS Medicare Part B Payment Limit File (quarterly), Q3 2026.
Full HCPCS code details (official CMS record)
Long descriptionInjection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg
CoverageC — Carrier/MAC judgment
Pricing indicator51 — Drug — priced under the ASP methodology
Type of service1 — Medical care
BETOS-2O1D
ASC payment groupYY
Action codeN — No maintenance this year
Effective date2021-01-01
Date added2021-01-01
Source: CMS HCPCS Level II code file (imported via admin).
🧮 Dosing & billing-units calculator HCPCS UNITS
One billing unit of J9316 = 10 mg. Enter a regimen to convert dose → billing units and project a full course.
Billing units = dose ÷ HCPCS unit size. Most payers require whole units — round per the payer's policy. “Est. Medicare pay” uses the current payment limit. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (JZ when none is discarded) where allowed. Always verify payer-specific rounding before billing.
🔁 NDCs that bill under J9316 WITH EST. MEDICARE PAY
2 NDCs map to J9316. Bill units = how many HCPCS units one package represents. Est. pay / pkg = payment limit ($59.895/unit) × that package's bill units.
| NDC (11-digit) | Drug | Labeler | Package | Strength | Bill units | Est. pay / pkg | NADAC / unit | Status | Source |
|---|---|---|---|---|---|---|---|---|---|
| 50242-0245-01 | Phesgo pertuzumab, trastuzumab, and hyaluronidase-zzxf 1200 mg/15mL; 600 mg/15mL; 30000 U/15mL INJECTION, SOLUTION | Genentech, | 1 VIAL, SINGLE-DOSE in 1 CARTON (50242-245... | 1200 mg/15mL; 600 mg/15mL; 30000 U/15mL | 180 | $10,781.10 | — | ● Active | CMS ASP |
| 50242-0260-01 | Phesgo pertuzumab, trastuzumab, and hyaluronidase-zzxf 600 mg/10mL; 600 mg/10mL; 20000 U/10mL INJECTION, SOLUTION | Genentech, | 1 VIAL, SINGLE-DOSE in 1 CARTON (50242-260... | 600 mg/10mL; 600 mg/10mL; 20000 U/10mL | 120 | $7,187.40 | — | ● Active | CMS ASP |
NDC→HCPCS mappings come from the CMS ASP NDC-HCPCS crosswalk; additional DME MAC / DMEPOS mappings come from PDAC and are labeled separately. NADAC from CMS (weekly). “Status” reflects the product's marketing / obsolete flag in the NDC directory. Presence or absence here does not determine Medicare coverage. Linked NDCs open the full product page.
📊 Medicare utilization & spend CMS · PART B · 2026 (Q1)
Period
Total Part B spend
$38.43M
Claims
5,254
Beneficiaries
1,814
Spend / beneficiary
$21,184.87
Spend / claim
$7,314.30
Trend by period
Where J9316 ranks among Part B drugs · 2026 (Q1) · neighbors ±5
Total spending — #82 of 824
#77
VECTIBIX J9303
$41.65M
#78
MONOFERRIC J1437
$41.02M
#79
TALVEY J3055
$40.41M
#80
YUPELRI J7677
$40.3M
#81
UDENYCA AUTOINJECTOR... Q5111
$39.49M
#82
PHESGO J9316
$38.43M
#83
IDOSE TR J7355
$38.31M
#84
TYVASO INSTITUTIONAL... J7686
$36.52M
#85
CAPVAXIVE 90684
$36.18M
#86
NULOJIX J0485
$34.95M
#87
TYSABRI J2323
$34.71M
Total claims — #217 of 824
#212
DESCOVY J0751
5,521
#213
CYCLOPHOSPHAMIDE(J90... J9073
5,505
#214
KANJINTI Q5117
5,430
#215
TEMOZOLOMIDE J8700
5,402
#216
NAROPIN* J2795
5,366
#217
PHESGO J9316
5,254
#218
ATROPINE SULFATE(J04... J0461
5,212
#219
TECVAYLI J9380
5,187
#220
MULTIHANCE A9577
5,179
#221
TRIVISC J7329
5,171
#222
EVEROLIMUS* J7527
5,068
Top Medicare Part B drugs by the selected metric. Click any drug to open its J-code page. Source: CMS Medicare Quarterly Part B Spending by Drug.
Full breakdown by period (2)
| Period | Total spend | Beneficiaries | Claims | $/beneficiary | $/claim |
|---|---|---|---|---|---|
| 2026 (Q1) | $38.43M | 1,814 | 5,254 | $21,184.87 | $7,314.30 |
| 2025 (Q1-Q4) | $154.34M | 2,778 | 20,407 | $55,557.22 | $7,562.99 |
Provider-administered (Part B) spend, calculated for the whole HCPCS code (CMS does not publish Medicare spend per individual NDC). Self-administered use is covered under Part D instead. A blank patient count means fewer than 11 people — CMS hides counts that small to protect privacy. Source: CMS Medicare Quarterly Part B Spending by Drug (data.cms.gov), updated quarterly.
📈 Medicare Part B claims detail CMS PSPS · 2024
Calendar-year 2024 Medicare Part B fee-for-service activity for this HCPCS code, summed across all carriers, localities and specialties (CMS Physician/Supplier Procedure Summary). A “service” is one billed line/unit — not one claim — so counts run higher than claim counts.
Allowed charges
$74.21M
Medicare paid
$57.64M
Submitted services
1,218,748
Denial rate
3.1%
Allowed / service
$62.82
Submitted charges
$236.56M
Source: CMS Physician/Supplier Procedure Summary (PSPS), CY2024 — Medicare Part B carrier + DME fee-for-service claims (excludes Medicare Advantage). Figures are for the whole HCPCS code, which may cover uses beyond this drug. ⚠ CMS hides any figure covering fewer than 11 patients (a privacy rule), so totals — especially denials and low-volume codes — run a little low.
🗃️ Data sources & freshness
Every figure on this page is computed from public datasets. Here's what each section draws on and how current it is.
HCPCS code & descriptor
CMS HCPCS Level II code file
Loaded
Payment limit & billing unit
CMS Medicare Part B ASP Pricing File (quarterly)
Q3 2026 · as of 2026-08-20
NDC ↔ HCPCS crosswalk
CMS ASP NDC-HCPCS crosswalk
2 NDCs mapped
NADAC acquisition cost
CMS National Average Drug Acquisition Cost (weekly)
Not available for mapped NDCs
Utilization & spend
CMS Part B Spending by Drug · PSPS · Physician & Other Practitioners
Latest data year 2026
Figures are estimates for reference and may lag the source files. Always verify against the current CMS files and your payer's policy before submitting claims.
⚠️ Practical billing caveats
- A crosswalk is not coverage. An NDC mapping or a published payment limit does not guarantee a payer will cover or pay this code. Check the specific plan's policy.
- Units ≠ milligrams. Bill the number of HCPCS units (dose ÷ the code's unit size), not the milligram dose. Use the calculator above.
- Discarded drug. For single-dose vials, drug discarded after administration may be separately billable with modifier JW (and JZ when nothing is discarded) where the payer allows.
- Rounding & partial units. Many payers require whole units; round per the payer's policy, not automatically up.
- The code can cover more than this drug. Some HCPCS codes span multiple products or strengths — confirm the exact code for the product administered.
- Figures lag. ASP limits change quarterly and utilization data are released with a delay. Verify against the current CMS files before billing.
❓ J9316 billing FAQ
What is HCPCS code J9316?
J9316 is a HCPCS Level II J-code used to bill Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg under Medicare Part B and most medical (not pharmacy) benefits.
What is the billing unit for J9316?
One unit of J9316 represents 10 MG. Report the number of units equal to the dose administered divided by 10 MG.
How many units of J9316 should I bill?
Divide the dose administered by the code's unit size (10 MG) to get the number of billing units, then round per your payer's policy. The calculator on this page converts a dose into billing units and projects a full course.
How much does Medicare pay for J9316?
The Medicare Part B payment limit is $59.895 per unit (Q3 2026), based on ASP + 6%. After the 2% sequester the effective payment is about $58.697 per unit. Payment limits are revised quarterly.
Which NDCs bill under J9316?
2 NDCs currently map to J9316 in the CMS ASP NDC-HCPCS crosswalk. See the NDC crosswalk table above for each product, package, billing units and estimated reimbursement.
Does a crosswalk mean J9316 is covered?
No. An NDC-to-HCPCS crosswalk and a published payment limit do not guarantee coverage or payment. Coverage depends on the payer, the diagnosis and the site of care — always verify the current policy before billing.
For professional billing reference only — verify against the current CMS files before submitting claims.