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HCPCS code J9354: Ado-trastuzumab emtansine, per 1 mg2026 Medicare rate & RVUs

Reports each milligram of intravenous ado-trastuzumab emtansine administered for HER2-positive breast cancer treatment in an oncology setting.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J9354

Ado-trastuzumab emtansine, per 1 mg

Office or facility?

Work RVUs
0
Total RVUs
0.00
Global days
XXX

National rate · 2026

—

Not priced in the facility setting.

See every locality for J9354 →Billed by an NP, PA or therapist? →

Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.

Your location

Medicare pays by the payment locality where the service is performed.

On this page 10 sections
  1. Medicare rate
  2. What J9354 covers
  3. By payment locality
  4. Rate map
  5. How it’s calculated
  6. Payment rules
  7. Similar codes
  8. Related codes
  9. Billing questions
  10. Sources

What J9354 covers

Ado-trastuzumab emtansine, also called T-DM1, is an intravenous HER2-directed antibody-drug conjugate used to treat HER2-positive breast cancer. Oncology clinicians administer it by infusion, including for unresectable or metastatic disease and for certain patients with residual invasive disease after neoadjuvant treatment. The drug combines trastuzumab with a cell-killing agent; it is distinct from trastuzumab given alone and from other HER2-directed conjugates.

For Medicare, CMS assigns status E, excluding this drug from the physician fee schedule; when Medicare covers it, payment is under another method. CMS classifies it as a Part B drug, generally priced from the quarterly Average Sales Price files when covered. Coverage is left to the Medicare contractor's judgment. Each HCPCS unit represents 1 mg, so report units based on the total milligrams administered.

This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.

Where J9354 pays more and less

The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.

109 of 109 payment localities

J9354 office and facility rates by payment locality
Payment localityOfficeFacility
AlabamaUnavailableUnavailable
AlaskaUnavailableUnavailable
ArizonaUnavailableUnavailable
ArkansasUnavailableUnavailable
Atlanta, GAUnavailableUnavailable
Austin, TXUnavailableUnavailable
Bakersfield, CAUnavailableUnavailable
Baltimore area, MDUnavailableUnavailable
Beaumont, TXUnavailableUnavailable
Brazoria, TXUnavailableUnavailable

J9354 rates by state

Office rate range in each state. Select a state to see its payment localities.

MEWIVTNHMTNDMNMINYMARIWAIDWYSDIAILINOHPANJCTORNVUTCONEMOKYWVVAMDDECAAZNMKSOKARTNNCSCDCTXLAMSALGAFLAKHI

Explore a state

Local rates. Clear comparisons.

Hover or focus a tile to see its rate range. Select it to open the state’s fee schedule.

View every state and territory as a table
J9354 office rate range by state
State / territoryOffice rate rangeLocalities
AKNo published base rate1
ALNo published base rate1
ARNo published base rate1
AZNo published base rate1
CANo published base rate29
CONo published base rate1
CTNo published base rate1
DCNo published base rate1
DENo published base rate1
FLNo published base rate3
GANo published base rate2
GUNo published base rate1
HINo published base rate1
IANo published base rate1
IDNo published base rate1
ILNo published base rate4
INNo published base rate1
KSNo published base rate1
KYNo published base rate1
LANo published base rate2
MANo published base rate2
MDNo published base rate3
MENo published base rate2
MINo published base rate2
MNNo published base rate1
MONo published base rate3
MSNo published base rate1
MTNo published base rate1
NCNo published base rate1
NDNo published base rate1
NENo published base rate1
NHNo published base rate1
NJNo published base rate2
NMNo published base rate1
NVNo published base rate1
NYNo published base rate5
OHNo published base rate1
OKNo published base rate1
ORNo published base rate2
PANo published base rate2
PRNo published base rate1
RINo published base rate1
SCNo published base rate1
SDNo published base rate1
TNNo published base rate1
TXNo published base rate8
UTNo published base rate1
VANo published base rate2
VINo published base rate1
VTNo published base rate1
WANo published base rate2
WINo published base rate1
WVNo published base rate1
WYNo published base rate1

How the J9354 rate is calculated

Each of J9354’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.

How the rate is built · J9354

RVUs × geographic indexes × conversion factor

Office or facility?

Work0.00

0.00 RVUs× 1.000 GPCI

Practice expense0.00

0.00 RVUs× 1.000 GPCI

Malpractice0.00

0.00 RVUs× 1.000 GPCI

Adjusted RVUs

0.0000

Conversion factor

$33.4009

Medicare rate

$0.00

Every GPCI starts at 1.000, the national rate. Enter a ZIP or drag a slider.

Payment rules and modifiers for J9354

J9354 has no global surgery period, no multiple-procedure, bilateral or assistant-at-surgery adjustment, and no professional/technical split. What changes the payment is where the service happens: the place of service on the claim decides whether Medicare pays the office or the facility rate.

Place of service · J9354

Which rate does Medicare pay?

The POS code on the claim line (CMS-1500 box 24B).

POS 11 · non-facility rate · national

—

J9354 isn’t priced in this setting.

J9354 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • J9354

    Ado-trastuzumab emtansine, per 1 mg0 wRVU

    Not priced

  • J9355

    Trastuzumab injection, per 10 mg, non-biosimilar0 wRVU

    Not priced

  • J9356

    Trastuzumab combination, per 10 mg trastuzumab0 wRVU

    Not priced

  • J9358

    Fam-trastuzumab deruxtecan, per 1 mg0 wRVU

    Not priced

How to choose

J9355Trastuzumab injectionPer 10 mg, non-biosimilar
J9355 represents trastuzumab without an attached emtansine drug. Use J9354 for the trastuzumab-emtansine conjugate.
J9356Trastuzumab combinationPer 10 mg trastuzumab
J9356 represents subcutaneous trastuzumab with hyaluronidase. J9354 is the intravenous trastuzumab-emtansine conjugate.
J9358Fam-trastuzumab deruxtecanPer 1 mg
J9358 represents fam-trastuzumab deruxtecan, a different antibody-drug conjugate. J9354 represents ado-trastuzumab emtansine.

Codes related to J9354

Related codes aren’t interchangeable: bill the code that matches the service performed.

Codes related to J9354
CodeHow it relatesNational office range
Often billed with
96413Chemo IV infusion, initial drug, first hourChemotherapy infusion administration code that may be reported for the drug infusion.$114.99–$186.95
Used instead
J9355Trastuzumab injection, per 10 mg, non-biosimilarTrastuzumab without emtansine, used when that distinct HER2-directed drug is selected.No office rate
J9358Fam-trastuzumab deruxtecan, per 1 mgA different HER2-directed antibody-drug conjugate used in a different treatment regimen.No office rate

J9354 billing questions

How many units should be reported?

One unit represents 1 mg. Convert the administered dose in milligrams to the corresponding number of units.

Does status E mean Medicare never covers this drug?

No. Status E excludes it from the physician fee schedule; when covered, Medicare pays under another method. Coverage is left to the Medicare contractor's judgment.

Is J9354 the same drug as trastuzumab alone?

No. J9354 represents trastuzumab linked to emtansine. J9355 represents trastuzumab without emtansine.

Does J9354 include the infusion service?

J9354 reports the drug in milligrams, not the infusion administration. The administration service is reported separately when appropriate.

When is J9354 different from J9358?

J9354 is ado-trastuzumab emtansine. J9358 is a different HER2-directed antibody-drug conjugate, fam-trastuzumab deruxtecan.

Where these rates come from

FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.

CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027

Open CMS sourceHow we calculate rates

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