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    v1.0.28
    OpenPayerBilling CodesChemotherapy DrugsHCPCS hcpcs-j9306-pertuzumab-injection-1mg-oncology-infusion
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    HCPCS Level II J9306: Injection, pertuzumab, 1 mg

    Commercial payers pay $79 on average nationally for this procedure.

    HCPCS Level II code J9306 represents the drug supply for pertuzumab, billed per 1 mg of the injected monoclonal antibody; the service is a parenteral oncology infusion typically administered in an outpatient infusion center or hospital outpatient department for treatment of HER2-positive breast cancer.

    For related coverage guidance, see recent payer policy updates: Epithelial Cell Cytology in Breast Cancer Risk Assessment, Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only), Antibody-Drug Conjugates.

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    National Reimbursement Benchmarks

    Commercial commercial average (BUCA) for HCPCS J9306 centers near $78.70, while individual national commercial payers display varied central tendencies: Aetna’s median is $17.00, Blue Cross Blue Shield’s median is $15.80, Cigna’s median is $17.00, and UnitedHealth Group’s median is $18.00. These medians cluster in the mid-teens, but BUCA’s mean at $78.70 indicates that broader commercial contracting can sit considerably higher than the typical payer median, reflecting heavier weight from higher outliers in pooled commercial arrangements.

    Dispersion measured as P75 minus P25 highlights relative tightness: Blue Cross Blue Shield’s dispersion is $1.50 (P75 $16.80 minus P25 $15.30) and UnitedHealth Group’s dispersion is $2.50 (P75 $19.50 minus P25 $17.00), which are the tightest spreads. Aetna’s dispersion is unusually wide at $12.30 (P75 $17.00 minus P25 $4.70), indicating substantial heterogeneity in allowed amounts. Cigna’s dispersion is $2.30 (P75 $19.30 minus P25 $17.00), and BUCA’s interquartile band (P75 $17.50 minus P25 $14.30) is $3.20, placing it between the tightest payers and Aetna’s wide variation.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A typical patient is an adult female diagnosed with HER2-positive invasive breast cancer involving the nipple/areola (e.g., C50.011 or C50.012) who is receiving systemic anti-HER2 targeted therapy. Pertuzumab (J9306) is supplied as an injectable biologic dosed and billed per milligram; the oncology team prepares a weight-based dose in the infusion suite or hospital outpatient infusion center. The clinical workflow includes: pre-infusion verification (consent, allergy review, current weight and labs), pharmacy compounding of the pertuzumab vial(s) to the ordered mg dose, administration via intravenous infusion by an oncology nurse with continuous monitoring for infusion reactions, documentation of lot number and administered mg, and post-infusion observation and discharge instructions. Billing typically pairs the drug HCPCS J9306 with chemotherapy administration CPT codes such as 96413 for the initial infusion hour and 96415 for additional infusion time, and may include supportive care medications as separate line items. Providers involved commonly are Medical Oncology or Hematology & Oncology physicians and infusion nursing staff working in outpatient infusion centers, hospital outpatient departments, or ambulatory infusion clinics.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure

    Related Modifiers

    8 rows

    ModifierDescriptionWhen to Use
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    78CPT modifier -78 indicates an unplanned, related return to the operating or procedure room by the same provider during the global postoperative period. It is appended when treatment for a…- Use modifier -78 when an unplanned, related complication during the original procedure’s global postoperative period requires the patient to return to a formal operating or procedure room and the…
    80CPT® Modifier 80 (Assistant Surgeon) is appended to a surgical CPT code when a physician (MD or DO) provides full, continuous assistance throughout the operative procedure. It is intended only for…- Use CPT Modifier -80 when a physician (MD or DO) serves as an assistant surgeon and provides full, continuous assistance throughout the entire operative procedure; append -80 to the surgical CPT…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    62Modifier 62 indicates that two surgeons function as co‑surgeons, each performing distinct parts of the same primary surgical procedure. It is appended to the primary procedure code (and any…- Use modifier -62 when two surgeons act as co‑surgeons (both primary surgeons) on a single definitive primary procedure, each performing distinct parts of the same surgical procedure (append -62 to…

    Related Provider Taxonomies

    8 rows

    Taxonomy CodeSpecialtyNotes
    207RH0003XHematology & Oncology PhysicianAn internist doctor of osteopathy that specializes in the treatment of the combination of hematology and oncology disorders. A doctor of osteopathy t…
    207RX0202XMedical Oncology PhysicianAn internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on a…
    2084P0800XPsychiatry PhysicianA Psychiatrist specializes in the prevention, diagnosis, and treatment of mental disorders, emotional disorders, psychotic disorders, mood disorders, …
    1223P0300XPeriodonticsThat specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the tee…
    207QS0010XSports Medicine (Family Medicine) PhysicianA family medicine physician that is trained to be responsible for continuous care in the field of sports medicine, not only for the enhancement of hea…
    2279H0200XHome Health Registered Respiratory TherapistHome care fosters individual responsibility for self-management of chronic respiratory conditions. It includes individualized assessment based plans …
    2279P1005XPulmonary Rehabilitation Registered Respiratory TherapistThe respiratory therapist can assist the chronic pulmonary patient in returning to an optimal role in society by providing an effective program. It i…
    3336C0002XClinic PharmacyA pharmacy in a clinic, emergency room or hospital (outpatient) that dispenses medications to patients for self-administration under the supervision o…

    Related Payer Policy Updates

    Specialty: Hematology/Oncology1 / 3

    4 rows

    PolicyPayerEffective Date
    Epithelial Cell Cytology in Breast Cancer Risk AssessmentOscar Health2026-10-01
    Chemotherapy Observation or Inpatient Hospitalization (for New Mexico Only)UnitedHealthcare2026-08-01
    Antibody-Drug ConjugatesPremera Bluecross2026-08-01
    Umbilical Cord Blood Harvesting and Storage for Future Use (for Indiana Only)UnitedHealthcare2026-08-01

    Related Codes

    HCPCS-J9000-DOXORUBICIN-10MG-INJECTION

    HCPCS J9000: Doxorubicin Hydrochloride Injection, 10 mg

    HCPCS-J9003-LEUPROLIDE-INJECTABLE-CAMCEVI-1MG

    HCPCS Level II J9003: Leuprolide injectable (camcevi etm), 1 mg

    HCPCS-J9010-ALEMTUZUMAB-INJECTION-10MG

    HCPCS Level II J9010: Injection, alemtuzumab, 10 mg

    HCPCS-J9011-DATOPOTAMAB-DERUXTECAN-INJECTION-1MG

    HCPCS J9011: Datopotamab Deruxtecan Injection, 1 mg

    HCPCS-J9015-ALDESLEUKIN-INJECTION-SINGLE-USE-VIAL

    HCPCS Level II J9015: Aldesleukin Injection, Single-Use Vial

    HCPCS-J9017-ARSENIC-TRIOXIDE-INJECTION-1MG

    HCPCS J9017: Arsenic Trioxide Injection, 1 mg

    HCPCS-J9019-ASPARAGINASE-ERWINAZE-INJECTION-1000-IU

    HCPCS Level II J9019: Asparaginase (Erwinaze) Injection, 1,000 IU

    HCPCS-J9020-ASPARAGINASE-INJECTION-10000-UNITS

    HCPCS J9020: Asparaginase Injection, 10,000 Units

    HCPCS-J9021-ASPARAGINASE-RYLAZE-INJECTION-0-1-MG

    HCPCS Level II J9021: Injection, asparaginase (Rylaze), 0.1 mg

    HCPCS-J9022-ATEZOLIZUMAB-INJECTION-10MG

    HCPCS J9022: Injection, atezolizumab 10 mg

    Showing 1–10 of 227

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    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

    96413Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drugBilled for the initial infusion time when pertuzumab is administered as the primary drug during the encounter.
    96415Chemotherapy administration, intravenous infusion technique; each additional hourBilled for each additional hour of infusion time beyond the initial hour when the pertuzumab infusion requires longer administration or concurrent infusions extend time.
    J9355Injection, trastuzumab, 10 mgCommonly administered alongside pertuzumab in HER2-positive breast cancer regimens; billed per unit for trastuzumab.
    J9312Injection, rituximab, 10 mgAn example of another monoclonal antibody J-code used in oncology; included as a related oncology injectable code though not typically combined with pertuzumab in breast cancer regimens.