HERCEPTIN HYLECTA J Code: J9356

Drug & Product Overview

HCPCS Descriptor Injection, trastuzumab, 10 mg and hyaluronidase-oysk

HCPCS Added Date July 1, 2019

Manufacturer Genentech

Route of Administration Subcutaneous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Solution

About HERCEPTIN HYLECTA

Herceptin Hylecta is a medication aligned to the HCPCS J Code: J9356 for billing, pricing, and reimbursement purposes in the United States. Classified under Oncology, it is administered via the subcutaneous route and manufactured by Genentech.

According to CMS Drug Use Information: Trastuzumab is used to treat breast cancer. Trastuzumab belongs to a class of medications known as monoclonal antibodies. It works by slowing or stopping the growth of cancer cells. This product also contains hyaluronidase, which helps your body absorb trastuzumab given by injection under the skin. This monograph is about the following trastuzumab products: trastuzumab (subcutaneous) and trastuzumab-hyaluronidase-oysk. These products are not the same as other trastuzumab products, including trastuzumab emtansine, or trastuzumab given by injection into a vein, and should not be used in place of each other.

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
50242-0077-01	Herceptin Hylecta	Genentech, Inc.	60	600 MG / 5 ML

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HERCEPTIN HYLECTA Pricing & Reimbursement

J9356 Private Payer Reimbursement

$63.56 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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Historical Graphing and Billing Calculator

per HCPCS unit

As of Q4 2026

HERCEPTIN HYLECTA Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 15.32%

Avg. Days to File 6.4days

Avg. Days to Pay 23.3days

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

Explore J9356 claims analytics on FocalPoint →

HERCEPTIN HYLECTA CPT Administration Codes

CPT Code	Description
96401	Chemotherapy administration, subcutaneous or intramuscular; non-hormonal anti-neoplastic

JW / JZ modifiers apply

CMS has identified Herceptin Hylecta (J9356) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

HERCEPTIN HYLECTA Medically Unlikely Edits (MUE)

The most billing units of J9356 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient

60 units / day

= 600 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 →

HERCEPTIN HYLECTA 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.

Breast Cancer Metastatic Breast Cancer

Drug Class

Endoglycosidase [EPC]Glycoside Hydrolases [CS]HER2/Neu/cerbB2 Antagonists [MoA]HER2/neu Receptor Antagonist [EPC]

Frequently Asked Questions

Is there an available Herceptin Hylecta billing and coding guide?

Billing and coding information for HERCEPTIN HYLECTA can be found through Genentech. Visit Here →

Are there any available Herceptin Hylecta patient assistance programs?

HERCEPTIN HYLECTA patient assistance information can be found through Genentech. Visit Here →

Where can I find Herceptin Hylecta prescribing information?

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

Where can I find Herceptin Hylecta side effect information?

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

Does billing HERCEPTIN HYLECTA require JZ/JW wastage modifiers?

CMS has identified HERCEPTIN HYLECTA(J9356) 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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