ERBITUX J Code: J9055

Drug & Product Overview

HCPCS Descriptor Injection, cetuximab, 10 mg

HCPCS Added Date January 1, 2005

Manufacturer Eli Lilly and Company

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Solution

About ERBITUX

Erbitux is a medication aligned to the HCPCS J Code: J9055 for billing, pricing, and reimbursement purposes in the United States. It is an Oncology drug administered via the intravenous route and manufactured by Eli Lilly and Company.

According to CMS Drug Use Information: Cetuximab is used to treat a certain type of cancer of the colon (large intestine) or rectum. This medication is also used to treat head and neck cancer. Cetuximab works by slowing or stopping the growth of cancer cells. It binds to a certain protein (epidermal growth factor receptor-EGFR) in some tumors. Cetuximab is a man-made protein (monoclonal antibody).

Disclaimer: This is a summary and does not contain all possible information about this product. For complete information about this product or your specific health needs, ask your healthcare professional.

NDC Code Information

Based on publicly available CMS files. The list of NDCs below is not exhaustive.

NDC Code	Drug	Manufacturer	Billing Units / Pkg	Package Size
66733-0948-23	Erbitux	ImClone LLC	10	100 MG / 50 ML
66733-0958-23	Erbitux	ImClone LLC	20	200 MG / 100 ML

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ERBITUX Pricing & Reimbursement

J9055 Private Payer Reimbursement

$82.78 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

Create an account on PayerPrice for more information →

Historical Graphing and Billing Calculator

per HCPCS unit

As of Q3 2026

ERBITUX Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 14.37%

Avg. Days to File 9.3days

Avg. Days to Pay 24.3days

Real-world claims performance from FocalPoint, OnPoint Oncology's reimbursement analytics platform, with claims data accrued at the clearing house level.

Explore J9055 claims analytics on FocalPoint →

ERBITUX CPT Administration Codes

CPT Code	Description
96413	Chemotherapy administration, intravenous infusion technique; up to 1 hour, single or initial substance/drug
96415	Chemotherapy administration, intravenous infusion technique; each additional hour (List separately in addition to code for primary procedure)

JW / JZ modifiers apply

CMS has identified Erbitux (J9055) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

ERBITUX Medically Unlikely Edits (MUE)

The most billing units of J9055 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient

150 units / day

= 1,500 mg per day

MAI 3 · Date of Service Edit: Clinical. Per-day limit based on clinical expectations; excess units are denied but may be appealed with documentation of medical necessity. See all MUE limits →

ERBITUX Clinical Information

Indications and drug classification.

Treated Diseases & Conditions

This list of indications is not exhaustive and may be subject to errors. The information on BuyandBill.com is intended for informational purposes only and should not be used for medical advice.

BRAF V600E Mutation-Positive Metastatic Colorectal Cancer K-Ras Wild-type, EGFR-expressing Metastatic Colorectal Cancer Squamous Cell Carcinoma of the Head and Neck

Drug Class

Epidermal Growth Factor Receptor Antagonist [EPC]HER1 Antagonists [MoA]

Frequently Asked Questions

Is there an available Erbitux billing and coding guide?

Billing and coding information for ERBITUX can be found through Eli Lilly and Company. Visit Here →

Are there any available Erbitux patient assistance programs?

ERBITUX patient assistance information can be found through Eli Lilly and Company. Visit Here →

Where can I find Erbitux prescribing information?

ERBITUX prescribing information can be found at the link below: Visit Here →

Where can I find Erbitux side effect information?

Information regarding ERBITUX's side effects can be found at MedlinePlus Visit Here →

Does billing ERBITUX require JZ/JW wastage modifiers?

CMS has identified ERBITUX(J9055) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. See CMS guidelines on use of the JZ and JW wastage modifiers below.

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