Summary & Overview
HCPCS Level II J9310: Injection, Rituximab 100 mg
HCPCS Level II code J9310 designates a 100 mg unit of rituximab, a monoclonal antibody used in oncology and selected autoimmune conditions. As a billed drug code, J9310 is used to capture per‑unit administration of rituximab in outpatient infusion settings, influencing facility and professional payment for biologic therapy. Nationally, accurate coding of unitized drug HCPCS codes like J9310 matters for payment integrity, drug utilization monitoring, and cost reporting for high-cost biologics.
Key payers discussed include Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, and Medicare. Readers will find a concise overview of clinical context for rituximab administration, typical sites of service, and what a J9310 line item represents on an outpatient claim. The publication covers benchmarks and payment considerations for unitized HCPCS drug billing, common reporting practices for infusion services, and relevant policy updates affecting Medicare and major commercial payers. Where input data is incomplete, the report notes missing fields and focuses on available national guidance and payer patterns. The content is intended to help billing managers, revenue cycle teams, and policy analysts interpret HCPCS Level II code J9310 on claims and understand its role in overall biologic therapy reimbursement.
Billing Code Overview
HCPCS Level II code J9310 represents an injection of rituximab, 100 mg administered as a therapeutic biologic. The service is a parenteral drug administration typically delivered in an outpatient infusion center, physician office, or ambulatory care setting where intravenous or subcutaneous biologic treatments are provided.
Service type: Injection — therapeutic monoclonal antibody
Typical site of service: Outpatient infusion center, physician office, ambulatory care clinic
Clinical & Coding Specifications
Clinical Context
A typical patient is a 62-year-old female with relapsed follicular non-Hodgkin lymphoma undergoing outpatient intravenous therapy. The oncology clinic schedules an infusion visit for administration of J9310 (injection, rituximab, 100 mg). Pre-visit workflow includes nursing triage, medication reconciliation, baseline vitals, review of prior infusion reactions, and verification of premedication (acetaminophen and antihistamine) orders. On arrival, the patient is registered, insurance and benefits verified (examples: Aetna, Blue Cross Blue Shield, Cigna Health, UnitedHealthcare, BUCA, Medicare), and consent for chemotherapy is confirmed. A pharmacist compounds the rituximab dose based on body surface area or fixed dosing per protocol and sends it to the infusion suite. Nursing performs an infusion start with graded rate escalation and continuous monitoring for infusion-related reactions; vital signs are documented before, during, and after infusion. If an acute reaction occurs, infusion is slowed or stopped and rescue medications are administered per institutional protocol. Post-infusion documentation includes dose administered, lot number, site of administration, and any adverse events; billing is submitted using J9310 units corresponding to the 100 mg increments administered. Typical sites of service are outpatient infusion center, physician office infusion suite, or hospital outpatient department.
Coding Specifications
| Modifier | Description | When to Use |
|---|---|---|
25 |