Fulvestrant

Injection, fulvestrant (teva), not therapeutically equivalent to j9395, 25 mg

Derived: 1 of 33 NDC package(s) for this drug appear in the CMS NDC–HCPCS crosswalk for J9393. CMS quarters Q1 2023 – Q1 2025Not in the latest CMS crosswalk.

J-codes are permanent national codes for drugs and biologicals — most often clinician-administered (buy-and-bill) products paid under Medicare Part B — plus certain immunosuppressive, inhalation (via DME), and oral anticancer/antiemetic drugs. Units are reported in multiples of the dosage in the code descriptor.

Home infusion per diem (S-codes)

When a home infusion pharmacy dispenses this drug, the drug is billed with the code above and each day of pharmacy services, supplies, and equipment with a per diem S-code. CMS publishes no drug-to-per-diem crosswalk, so CodeRx picks the therapy category from the FDA pharmacologic class and route. S-codes are not payable by Medicare; confirm the code against the payer contract.

• Hormonal therapy

  Derived calculationVerification needed

  Matched on: Estrogen Receptor Antagonist

  • S9560Hormonal therapy injection (e.g., leuprolide, goserelin)CMS: Home injectable therapy; hormonal therapy (e.g.; leuprolide, goserelin)

Home infusion per diem (S-codes)

Medicare

Not payable by Medicare — CMS coverage code I

Part B pricing indicator

00 — Not separately priced by Part B

National payment amount

None. No per diem code here is in the CMS Part B payment limit file for Q4 2026; CMS sets no national per diem rate.

Washington Apple Health (Medicaid)

Not on HCA’s Home Infusion Therapy/Parenteral Nutrition Program fee schedule (effective Jul 1, 2026), so these per diems are not separately paid. Home infusion is paid with the supply, pump, and nutrition codes in that schedule instead (below).

Billing unit

1 unit = 1 day on service (the CMS descriptor ends “per diem”)

Who sets the rate

Each commercial plan’s contract or state Medicaid fee schedule. Some payers reduce a second per diem billed for the same day.

Billed separately

The drug, with its own HCPCS code and units, and nursing visits — the CMS descriptor says “drugs and nursing visits coded separately”.

Verification neededCodeRx links to coverage documents instead of copying them: CMS distributes their code lists under AMA, ADA, and AHA license terms that limit reuse. Medicare Advantage, Medicaid, and commercial plans set their own coverage and prior-authorization rules.

Every import with its checksum is listed on the data sources page.