HCPCS Level II J9306: Injection of Pertuzumab, 1 mg
HCPCS Level II code J9306 denotes a 1 mg unit of pertuzumab, an injectable monoclonal antibody used in oncology care. The code is used to bill for the drug itself when administered as part of systemic cancer therapy in outpatient infusion centers and oncology clinics. Nationally, accurate reporting of drug J-codes like J9306 matters for treatment tracking, payer reimbursement consistency, and pharmacy-infusion inventory management.
This analysis covers coverage and billing considerations for major national payers: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of the code's clinical context, common associated administration codes, typical sites of service, and payer coverage landscape. The publication also summarizes common modifiers and related administration codes used alongside J9306, and highlights ICD-10 diagnoses commonly billed with pertuzumab.
Intended for billing managers, oncology group administrators, and policy analysts, the report provides benchmarks and policy-relevant details to support accurate coding and claims submission. Data not available in the input will be identified explicitly where applicable.
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Billing Code Overview
HCPCS Level II code J9306 represents an injection of pertuzumab, 1 mg. The service is a pharmacologic therapy delivered as an injectable biologic. The typical site of service for this medication is an outpatient infusion or oncology clinic, where intravenous or subcutaneous oncology therapies are administered.
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.