FULVESTRANT J Code: J9394
Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg
Drug & Product Overview
About FULVESTRANT
Fulvestrant is a medication aligned to the HCPCS J Code: J9394 for billing, pricing, and reimbursement purposes in the United States. It is an Oncology drug administered via the intramuscular route and manufactured by Fresenius Kabi.
According to CMS Drug Use Information: Fulvestrant is used to treat certain types of breast cancer. Breast cancer cells need the hormone estrogen in order to grow. Fulvestrant works by blocking the effect of estrogen, slowing tumor cell growth.
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
1 NDC package is crosswalked to J9394. Package detail is available to logged-in subscribers.
| NDC Code | Drug | Manufacturer | Billing Units / Pkg | Package Size |
|---|---|---|---|---|
| •••••-••••-•• Log in to view | FULVESTRANT | •••••••••••• Log in to view | •••• Log in to view | ••• •• / • •• Log in to view |
FULVESTRANT Pricing & Reimbursement
National median reimbursement across major commercial payers.
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Fulvestrant 505(b)(2) Information:
| HCPCS Code | Manufacturer | Active Ingredient | HCPCS Description |
|---|---|---|---|
| J9393 | Avyxa Pharma | Fulvestrant | Injection, fulvestrant (teva), not therapeutically equivalent to j9395, 25 mg |
| J9394 | Fresenius Kabi | Fulvestrant | Injection, fulvestrant (fresenius kabi) not therapeutically equivalent to j9395, 25 mg |
| J9395 | Generic Code (Multiple Manufacturers) | Fulvestrant | Injection, fulvestrant, 25 mg |
FULVESTRANT CPT Administration Codes
The below list of CPT codes is intended for informational purposes only and may not be exhaustive. CPT® codes and descriptions are copyright American Medical Association (AMA). All rights reserved.
| CPT Code | Description |
|---|---|
| 96401 | Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic |
CMS has identified Fulvestrant (J9394) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →
FULVESTRANT Medically Unlikely Edits (MUE)
The most billing units of J9394 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 25 mg.
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 →
FULVESTRANT Clinical Information
Indications and drug classification.
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.
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Frequently Asked Questions
Is there an available Fulvestrant billing and coding guide?
Are there any available Fulvestrant patient assistance programs?
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Where can I find Fulvestrant side effect information?
Does billing FULVESTRANT require JZ/JW wastage modifiers?
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