Home › Drug Codes › J Codes › J9355 · HERCEPTIN
Updated July 1st, 2026

HERCEPTIN J Code: J9355

Injection, trastuzumab, excludes biosimilar, 10 mg

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Q4 2026 Medicare Payment Limit for J9355, effective October 1, 2026: $68.871 per HCPCS billing unit, down 2.0% from $70.243. From CMS's final file.

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Medicare Payment Limit ?
$70.243
/ HCPCS billing unit · Q3 2026
APC Payment Limit ?
$70.243
/ HCPCS billing unit · APC 1613
ASP ?
$•••.••
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WAC · AWP ?
$•••.••
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NDCs Crosswalked ?
1
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Drug & Product Overview

HCPCS Descriptor Injection, trastuzumab, excludes biosimilar, 10 mg
HCPCS Added Date January 1, 2000
Manufacturer Genentech
Route of Administration Intravenous
Generic Status Single-Source; Branded
Dosage Type Single-Dose
Dosage Form Injection, Powder, Lyophilized, For Solution

About HERCEPTIN

Herceptin is a medication aligned to the HCPCS J Code: J9355 for billing, pricing, and reimbursement purposes in the United States. It is an Oncology drug administered via the intravenous route and manufactured by Genentech.

According to CMS Drug Use Information: Trastuzumab is used to treat certain types of breast, stomach, or esophagus cancer. Trastuzumab belongs to a class of medications known as monoclonal antibodies. It works by slowing or stopping the growth of cancer cells. This monograph is about the following trastuzumab products: trastuzumab, trastuzumab-anns, trastuzumab-dkst, trastuzumab-dttb, trastuzumab-pkrb, trastuzumab-qyyp, trastuzumab-strf.

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
50242-0132-01 Herceptin Genentech, Inc. 15 150 MG / 7.4 ML
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HERCEPTIN Pricing & Reimbursement

J9355 Private Payer Reimbursement
$76.66 / HCPCS unit as of Jan 2026

National median reimbursement across major commercial payers.

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UnitedHealthcare, BlueCross BlueShield, Aetna, Cigna

Historical Graphing and Billing Calculator

per HCPCS unit
As of Q3 2026

Trastuzumab Biosimilar Information:

HERCEPTIN Approval Date: September 25, 1998

Product Name HCPCS Code Active Ingredient BLA Type
Herceptin J9355 Trastuzumab 351(a) Originator Product
Ogivri Q5114 Trastuzumab 351(k) Biosimilar
Herzuma Q5113 Trastuzumab 351(k) Biosimilar
Ontruzant Q5112 Trastuzumab 351(k) Biosimilar
Trazimera Q5116 Trastuzumab 351(k) Biosimilar
Kanjinti Q5117 Trastuzumab 351(k) Biosimilar
Hercessi Q5146 Trastuzumab 351(k) Biosimilar

HERCEPTIN Claims Performance

Claims from Jan 2026 – Aug 2026
Claim Denial Rate 13.59%
Avg. Days to File 9.6days
Avg. Days to Pay 23.7days

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

Explore J9355 claims analytics on FocalPoint →
OnPoint Oncology

HERCEPTIN 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
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 Herceptin (J9355) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

HERCEPTIN Medically Unlikely Edits (MUE)

The most billing units of J9355 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient
120 units / day
= 1,200 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 →

mg Enter a dose to see how many billing units it is and whether it is under the limit.

HERCEPTIN 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.

Adjuvant Breast Cancer Metastatic Breast Cancer Metastatic Gastric Cancer
Drug Class
HER2/Neu/cerbB2 Antagonists [MoA]HER2/neu Receptor Antagonist [EPC]

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Frequently Asked Questions

Is there an available Herceptin billing and coding guide?
Billing and coding information for HERCEPTIN can be found through Genentech. Visit Here →
Are there any available Herceptin patient assistance programs?
HERCEPTIN patient assistance information can be found through Genentech. Visit Here →
Where can I find Herceptin prescribing information?
HERCEPTIN prescribing information can be found at the link below: Visit Here →
Where can I find Herceptin side effect information?
Information regarding HERCEPTIN's side effects can be found at MedlinePlus Visit Here →
Does billing HERCEPTIN require JZ/JW wastage modifiers?
CMS has identified HERCEPTIN(J9355) 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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Related Drug Codes

Explore billing, coding, and pricing for drugs related to HERCEPTIN.

Q5114OGIVRIInjection, trastuzumab-dkst, biosimilar, (ogivri), 10 mgBiocon Biologics IncAdded July 1, 2019Q5113HERZUMAInjection, trastuzumab-pkrb, biosimilar, (herzuma), 10 mgTevaAdded July 1, 2019Q5112ONTRUZANTInjection, trastuzumab-dttb, biosimilar, (ontruzant), 10 mgOrganonAdded July 1, 2019Q5117KANJINTIInjection, trastuzumab-anns, biosimilar, (kanjinti), 10 mgAmgenAdded October 1, 2019Q5116TrazimeraInjection, trastuzumab-qyyp, biosimilar, (trazimera), 10 mgPfizerAdded October 1, 2019Q5146HERCESSIInjection, trastuzumab-strf (hercessi), biosimilar, 10 mgAccordAdded January 1, 2025J9306PERJETAInjection, pertuzumab, 1 mgGenentechAdded January 1, 2014J9000ADRIAMYCINInjection, doxorubicin hydrochloride, 10 mgMultiple ManufacturersAdded January 1, 1984J9179HALAVENInjection, eribulin mesylate, 0.1 mgMultiple ManufacturersAdded January 1, 2012J9264ABRAXANEInjection, paclitaxel protein-bound particles, 1 mgMultiple ManufacturersAdded January 1, 2006