Phesgo J Code: J9316

Drug & Product Overview

HCPCS Descriptor Injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg

HCPCS Added Date January 1, 2021

Manufacturer Genentech

Route of Administration Subcutaneous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Solution

About Phesgo

Phesgo is a medication aligned to the HCPCS J Code: J9316 for billing, pricing, and reimbursement purposes in the United States. It is an Oncology drug administered via the subcutaneous route and manufactured by Genentech.

According to CMS Drug Use Information: This product contains 3 ingredients: pertuzumab, trastuzumab, and hyaluronidase. It is used to treat breast cancer. Pertuzumab and trastuzumab belong to a class of medications known as monoclonal antibodies. These medications work by slowing or stopping the growth of cancer cells. This product also contains hyaluronidase, which helps your body absorb pertuzumab and trastuzumab given by injection under the skin.

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
50242-0245-01	Phesgo	Genentech, Inc.	180	1200 MG / 15 ML
50242-0260-01	Phesgo	Genentech, Inc.	120	600 MG / 10 ML

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Phesgo Pricing & Reimbursement

J9316 Private Payer Reimbursement

$63.42 / 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 Q3 2026

Phesgo Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 12.44%

Avg. Days to File 6.8days

Avg. Days to Pay 22.3days

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

Explore J9316 claims analytics on FocalPoint →

Phesgo CPT Administration Codes

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

JW / JZ modifiers apply

CMS has identified Phesgo (J9316) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

Phesgo Medically Unlikely Edits (MUE)

The most billing units of J9316 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 10 mg.

Practitioner Office & Hospital Outpatient

180 units / day

= 1,800 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 →

Phesgo 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

Drug Class

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

Frequently Asked Questions

Is there an available Phesgo billing and coding guide?

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

Are there any available Phesgo patient assistance programs?

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

Where can I find Phesgo prescribing information?

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

Where can I find Phesgo side effect information?

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

Does billing Phesgo require JZ/JW wastage modifiers?

CMS has identified Phesgo(J9316) 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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