Intake card: J9312
Generated from CodeRx data on Nov 7, 2026. No patient information is entered or stored. Verify payer requirements before scheduling.
Billing
HCPCS codeJ9312 (active)
Billing unit10 MG
Part B limit$72.094 per unit (Q4 2026)
Max units / day (MUE)Practitioner 150 · Outpatient hospital 150
JW / JZSingle-dose containers on the CMS crosswalk: JW for discarded drug, JZ when none (Medicare Part B).
Medicare
Hospital outpatientK Paid separately (non-pass-through drug or biological) · $72.094 per unit (Q4 2026)
Home infusionPart B pays the drug at home only under the DME benefit (e.g. a pump drug under the External Infusion Pump policy, or IVIG for primary immune deficiency); otherwise Part D. Home infusion therapy services are paid only to Medicare HIT suppliers.
CoverageLCDs and articles for J9312 (Medicare Coverage Database)
Washington Apple Health
Professional claims$72.09 maximum allowable· PA
Hospital outpatientPaid by EAPG (3M grouper weight × the hospital's conversion factor); certain high-cost drugs are paid outside EAPG.
Home infusionHCA pays supply, pump, and parenteral nutrition codes from its home infusion schedule; per diem S-codes are not on it.
AAC = actual acquisition cost, based on NDC or invoice; BR = by report; NC = not covered; DC = not covered, see a different code; DP = covered under another program (see comments); PA = prior authorization; EPA = expedited prior authorization (see the billing guide); CPA = contractor prior authorization (Qualis). For professional claims; hospital-administered drugs are paid under HCA's outpatient (OPPS/EAPG) rules.
Products
NDCs on the current CMS crosswalk (2)
| NDC (11-digit) | Labeler | Package | Container | Units / pkg | Medicaid unit | N4 qualifier |
|---|---|---|---|---|---|---|
| 50242-0051-21 | Genentech, Inc. | 1 VIAL, SINGLE-USE in 1 CARTON (50242-051-21) / 10 mL in 1 VIAL, SINGLE-USE | single-dose | 10 | ML (Milliliter) | ML |
| 50242-0053-06 | Genentech, Inc. | 1 VIAL, SINGLE-USE in 1 CARTON (50242-053-06) / 50 mL in 1 VIAL, SINGLE-USE | single-dose | 50 | ML (Milliliter) | ML |
Intake checklist
- Confirm the patient's coverage and whether the drug is on the medical or the pharmacy benefit.
- Apple Health (professional claims): PA required — see HCA's prior authorization page.
- Medicare: check the MAC's LCDs and billing articles for covered diagnoses (coverage link below).
- Single-dose container: record any discarded amount (JW line) or bill JZ when none is discarded (Medicare Part B).
- Bill the 11-digit NDC with the N4 qualifier, unit qualifier, and quantity; Apple Health requires the NDC on professionally administered drug claims.
- Home infusion (not a Medicare HIT supplier): Medicare pays the drug at home only under Part B DME rules or as Part D; no Medicare payment for home infusion services.
Calculate units and claim lines · Compare HOPD and home infusion
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