HCPCS code J9312 — Inj., rituximab, 10 mg.
Status: Active.
Effective Jan 1, 2019.
Source: CMS HCPCS Level II.
J9312
ActiveInj., rituximab, 10 mg
Injection, rituximab, 10 mg
Category:
Drugs
Section:
J-codes: Drugs Administered Other Than Oral Method
Effective:
Jan 1, 2019
Code type:
alphanumeric
OPPS Status:
K
— Non-pass-through drugs and biologicals
OPPS APC:
9186
Drug class:
Anti-CD20 Monoclonal Antibodies
Medicare Part B utilization — 2023
Services billed
980,000
Beneficiaries
78,000
Medicare paid
$94,080,000
Avg per service
$120.00
Source: Medicare Part B Provider Utilization Public Use File (anonymized, aggregated to HCPCS level).
MUE — Medically Unlikely Edits
Maximum units of J9312 Medicare will pay for one beneficiary on one date of service. Claims exceeding the MUE are denied or returned for review.
| Service Type | Max Units / Day |
|---|---|
| Outpatient Hospital | 150 |
| Practitioner Services | 150 |
Source: CMS Medicare NCCI Medically Unlikely Edits
NDC Crosswalk
National Drug Codes (NDCs) mapped to this HCPCS code.
| NDC | Drug Name |
|---|---|
| 50242-0051-21 | Rituxan |
| 50242-0053-06 | Rituxan |