POLIVY J Code: J9309

Drug & Product Overview

HCPCS Descriptor Injection, polatuzumab vedotin-piiq, 1 mg

HCPCS Added Date January 1, 2020

Manufacturer Genentech

Route of Administration Intravenous

Generic Status Single-Source; Branded

Dosage Type Single-Dose

Dosage Form Injection, Powder, Lyophilized, For Solution

About POLIVY

Polivy is a medication aligned to the HCPCS J Code: J9309 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: Polatuzumab is used to treat certain types of cancer (diffuse large B-cell lymphoma-DLBCL, high-grade B-cell lymphoma-HGBL). This medication works by stopping the growth of cancer cells.

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
50242-0103-01	Polivy	Genentech, Inc.	30	30 MG / 1.88 ML
50242-0105-01	Polivy	Genentech, Inc.	140	140 MG / 7.52 ML

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POLIVY Pricing & Reimbursement

J9309 Private Payer Reimbursement

$141.71 / 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

POLIVY Claims Performance

Claims from Jan 2026 – Aug 2026

Claim Denial Rate 12.78%

Avg. Days to File 10.9days

Avg. Days to Pay 29.5days

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

Explore J9309 claims analytics on FocalPoint →

POLIVY 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 Polivy (J9309) as a HCPCS code with single-dose containers. Therefore, the JW/JZ wastage modifiers could be required for billing purposes. Wastage billing guide →

POLIVY Medically Unlikely Edits (MUE)

The most billing units of J9309 Medicare will pay for one patient in one day, as published by CMS. 1 unit = 1 mg.

Practitioner Office & Hospital Outpatient

280 units / day

= 280 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 →

POLIVY 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.

Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) Diffuse large B-cell lymphoma (DLBCL), not otherwise specified (NOS) or high-grade B-cell lymphoma (HGBL)

Frequently Asked Questions

Is there an available Polivy billing and coding guide?

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

Are there any available Polivy patient assistance programs?

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

Where can I find Polivy prescribing information?

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

Where can I find Polivy side effect information?

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

Does billing POLIVY require JZ/JW wastage modifiers?

CMS has identified POLIVY(J9309) 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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