HCPCS code J9354: Ado-trastuzumab emtansine, per 1 mg2026 Medicare rate & RVUs in Michigan
Reports each milligram of intravenous ado-trastuzumab emtansine administered for HER2-positive breast cancer treatment in an oncology setting.
CMS doesn’t publish an office rate for J9354 in Michigan.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
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On this page 9 sections
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 in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | Unavailable |
| Rest of Michigan | Unavailable | Unavailable |
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
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
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J9354 isn’t priced in this setting.
J9354 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
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