FeeBase
Log inGet started
Menu

HCPCS code J9356: Trastuzumab combination, per 10 mg trastuzumab2026 Medicare rate & RVUs

Reports subcutaneous trastuzumab with hyaluronidase-oysk for treatment of HER2-positive breast cancer, with each unit representing 10 mg of trastuzumab.

CMS RVU26DEffective Oct 1, 2026109 payment localities

Medicare rate · J9356

Trastuzumab combination, per 10 mg trastuzumab

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 J9356 →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 J9356 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 J9356 covers

J9356 represents the fixed-dose subcutaneous combination of trastuzumab and hyaluronidase-oysk. Oncology clinicians administer it for eligible patients with HER2-positive breast cancer, including in adjuvant and metastatic treatment settings. This is a subcutaneous product, distinct from intravenous trastuzumab products and from trastuzumab drug conjugates.

The code is excluded from the physician fee schedule under status E. When Medicare covers the drug, payment is made under another payment method; as a Part B drug, it is generally priced using CMS quarterly Average Sales Price files. Coverage is left to the Medicare contractor’s judgment. Each unit represents 10 mg of trastuzumab; report units based on the trastuzumab dose administered. The hyaluronidase is part of the combination represented by the code.

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 J9356 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

J9356 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

J9356 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
J9356 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 J9356 rate is calculated

Each of J9356’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 · J9356

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 J9356

J9356 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 · J9356

Which rate does Medicare pay?

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

POS 11 · non-facility rate · national

—

J9356 isn’t priced in this setting.

J9356 compared with similar codes

Compare codes · National

4 codes, side by side

Office or facility?

  • J9356

    Trastuzumab combination, per 10 mg trastuzumab0 wRVU

    Not priced

  • J9355

    Trastuzumab injection, per 10 mg, non-biosimilar0 wRVU

    Not priced

  • J9354

    Ado-trastuzumab emtansine, per 1 mg0 wRVU

    Not priced

  • J9358

    Fam-trastuzumab deruxtecan, per 1 mg0 wRVU

    Not priced

How to choose

J9355Trastuzumab injectionPer 10 mg, non-biosimilar
J9356 is the subcutaneous trastuzumab-hyaluronidase combination. J9355 is a different trastuzumab product for intravenous use.
J9354Ado-trastuzumab emtansinePer 1 mg
J9354 represents ado-trastuzumab emtansine, an antibody-drug conjugate. J9356 represents trastuzumab with hyaluronidase-oysk, without that conjugate.
J9358Fam-trastuzumab deruxtecanPer 1 mg
J9358 represents fam-trastuzumab deruxtecan, an antibody-drug conjugate. J9356 is the subcutaneous trastuzumab-hyaluronidase combination.

Codes related to J9356

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

Codes related to J9356
CodeHow it relatesNational office range
Used instead
J9355Trastuzumab injection, per 10 mg, non-biosimilarRepresents a different trastuzumab formulation used for intravenous administration.No office rate

J9356 billing questions

How is J9356 different from J9355?

J9356 represents subcutaneous trastuzumab combined with hyaluronidase-oysk. J9355 represents a different trastuzumab product and is used for the intravenous formulation.

How many units should be reported?

One unit represents 10 mg of trastuzumab. Calculate units from the trastuzumab dose administered, not from the amount of hyaluronidase.

Does status E mean Medicare never pays for J9356?

No. Status E means the code is excluded from the physician fee schedule; when Medicare covers the drug, payment is under another method. Coverage is left to the Medicare contractor’s judgment.

Does J9356 describe an intravenous or subcutaneous drug?

It describes the subcutaneous trastuzumab and hyaluronidase-oysk combination. Do not use it to represent an intravenous trastuzumab product.

What should the record support for J9356?

Document the drug administered, its subcutaneous route, the trastuzumab dose, and the units reported. The units correspond to 10 mg of trastuzumab each.

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

Did this answer your question about what J9356 pays?

Tell us what you were actually trying to work out. We’ll answer you directly, or build the page that does.

Fee sheets · Coming soon

Put J9356 and the rest of your codes on one sheet

Your codes at your locality, with payer contracts beside Medicare.

Join the waitlist