Summary & Overview

HCPCS Level II J2350: Ocrelizumab injection, 1 mg

Headline: HCPCS Level II code J2350: Ocrelizumab injection (1 mg) used in neurology care

Lead: HCPCS Level II code J2350 denotes a 1 mg dose of ocrelizumab administered for neurologic indications. The code is nationally relevant as biologic therapies for demyelinating and neuroinflammatory conditions carry specific billing, administration, and documentation considerations across major commercial payers.

What the code represents and why it matters: J2350 is a drug-specific HCPCS Level II code for ocrelizumab, a monoclonal antibody used in neurology. Its use intersects outpatient infusion workflows, physician specialty billing, and pharmacy-drug billing lines, making it an important component of neurology treatment costs and care delivery.

Key payers covered: Analysis includes major commercial payers — Aetna, Blue Cross Blue Shield, Cigna Health, and UnitedHealthcare — and addresses common coverage and billing patterns among them.

Overview of what readers will learn: The publication summarizes clinical context for use, typical outpatient hospital administration, related infusion service line coding, and common billing modifiers and practice patterns where available. It also provides guidance on claim line composition and operational considerations relevant to infusion services and physician specialty alignment. Policy updates, reimbursement benchmarks, and operational notes are discussed where available. If specific payer policy details are not provided in source inputs, the publication indicates "Data not available in the input."

AetnaBlue Cross Blue ShieldCigna HealthUnitedHealthcareJ2350HCPCS Level IIOcrelizumabNeurologyOutpatient InfusionInfusion BillingBiologic TherapyDrug J-Code

Billing Code Overview

HCPCS Level II code J2350 represents an injection of ocrelizumab, 1 mg. This billing code is used for administration of the monoclonal antibody therapy indicated in neurology practice settings. The service type associated with this code is Neurology, and the typical site of service for billing is an Outpatient Hospital (POS 22).

Clinical & Coding Specifications

Clinical Context

A 34-year-old patient with relapsing-remitting multiple sclerosis presents to an outpatient hospital infusion center for scheduled disease-modifying therapy with ocrelizumab. The neurology clinic has documented diagnosis G35 (Multiple sclerosis) and orders HCPCS Level II code J2350 for ocrelizumab dosed per milligram. The patient is registered at POS 22 (Outpatient Hospital). Nursing performs pre-infusion assessment, obtains baseline vitals and infusion consent, and establishes IV access. Pharmacy prepares ocrelizumab in a sterile environment and dispenses units billed per milligram using HCPCS Level II code J2350, with nursing administering the infusion over the prescribed timeframe. Infusion start and stop times, lot number, and any discarded drug amounts are documented. If any portion of the dispensed drug is discarded, modifier JW is applied. If an unrelated procedure is performed the same day that is distinct and separately reportable, modifier 59 is applied.

Coding Specifications

Modifiers:
JW — Drug amount discarded/not administered to any patient: Used when a portion of the drug vial(s) is discarded and must be reported for drug wastage tracking and appropriate billing adjustments when allowed by payors.
59 — Distinct Procedural Service: Used when a separate, identifiable service/procedure is performed on the same day as the infusion that is not normally reported together; indicates the services are distinct and separate.

National Reimbursement Benchmarks

National mean rates for HCPCS Level II code J2350 show a substantial gap between Medicare and average commercial benchmarks: Medicare (represented here by BUCA’s mean) is $663.67, while the composite commercial mean varies widely with Aetna at $2,429.16 and other major commercial payers clustered around $60–$66. This illustrates that some commercial contracts (notably Aetna) report much higher mean paid rates compared with Medicare/BUCA.

Rate dispersion, measured as the difference between the 75th and 25th percentiles, is tightest for Cigna Health (P75–P25 = 0) and relatively tight for UnitedHealthcare and BUCA/Medicare (P75–P25 = 4 and 4, respectively). Blue Cross Blue Shield shows a slightly wider dispersion (P75–P25 = 6), while Aetna exhibits the widest spread in percentiles (P75–P25 = 18.5), indicating greater variability in observed rates. The table and chart below present the full numerical breakdown.

National Mean Rates by Payer for HCPCS Level II code `J2350`

Related Codes

96365 — Intravenous infusion, for therapy, prophylaxis, or diagnosis; initial, up to 1 hour

Used to report the infusion administration visit when intravenous infusion time-based reporting is appropriate for a therapy infusion in the outpatient setting. Often billed alongside HCPCS Level II code J2350 to capture infusion administration time for documentation and reimbursement.

96366 — Intravenous infusion, for therapy, prophylaxis, or diagnosis; each additional hour

Used to report additional infusion time beyond the initial hour when the infusion duration exceeds one hour. May be reported with 96365 when ocrelizumab infusion requires extended infusion time.

96413 — Chemotherapy administration, intravenous; 1 hour

Occasionally used in oncology-style infusion workflows; not a drug code but an administration code for scheduled intravenous therapy lasting one hour. May be used in facilities that report chemotherapy administration codes for biologic infusions when clinically and payer-appropriate.

96415 — Chemotherapy administration, intravenous; each additional hour

Used to report each additional hour of chemotherapy-style administration beyond the initial hour; may be used in the same contexts described for 96413 when applicable.

Common pairings and alternatives:

J2350 is commonly billed with an infusion administration code such as 96365 (initial hour) and, if needed, 96366 (additional hours).
Administration codes 96413/96415 are alternatives in some facility billing models where biologic infusions are captured using chemotherapy administration codes.

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Summary & Overview

HCPCS Level II J2350: Ocrelizumab injection, 1 mg

Billing Code Overview

Clinical & Coding Specifications

Clinical Context

Coding Specifications

National Reimbursement Benchmarks

Related Diagnoses

Related Codes

National Reimbursement Benchmarks