KADCYLA J Code: J9354

Drug & Product Overview

HCPCS Descriptor Injection, ado-trastuzumab emtansine, 1 mg

HCPCS Added Date January 1, 2014

Manufacturer Genentech

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Powder, Lyophilized, For Solution

About KADCYLA

Kadcyla is a medication aligned to the HCPCS J Code: J9354 for billing, pricing, and reimbursement purposes in the United States. This Oncology medication is administered via the intravenous route and manufactured by Genentech.

According to CMS Drug Use Information: Trastuzumab emtansine is used to treat breast cancer. This medication is called a monoclonal antibody and microtubule inhibitor conjugate. It works by slowing or stopping the growth of cancer cells. This monograph is about the following trastuzumab emtansine products: trastuzumab emtansine, ado-trastuzumab emtansine.

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
50242-0087-01	Kadcyla	Genentech, Inc.	160	160 MG / 8 ML
50242-0088-01	Kadcyla	Genentech, Inc.	100	100 MG / 5 ML

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KADCYLA Pricing & Reimbursement

J9354 Private Payer Reimbursement

$43.73 / 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

KADCYLA Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 9.83%

Avg. Days to File 8.0days

Avg. Days to Pay 25.3days

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

Explore J9354 claims analytics on FocalPoint →

KADCYLA 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 Kadcyla (J9354) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

KADCYLA Medically Unlikely Edits (MUE)

The most billing units of J9354 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient

600 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 →

KADCYLA 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.

Early Breast Cancer Metastatic Breast Cancer

Frequently Asked Questions

Is there an available Kadcyla billing and coding guide?

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

Are there any available Kadcyla patient assistance programs?

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

Where can I find Kadcyla prescribing information?

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

Where can I find Kadcyla side effect information?

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

Does billing KADCYLA require JZ/JW wastage modifiers?

CMS has identified KADCYLA(J9354) 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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