HCPCS code J9356: Trastuzumab combination, per 10 mg trastuzumab2026 Medicare rate & RVUs in Michigan
Reports subcutaneous trastuzumab with hyaluronidase-oysk for treatment of HER2-positive breast cancer, with each unit representing 10 mg of trastuzumab.
CMS doesn’t publish an office rate for J9356 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 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 in Michigan
| Payment locality | Office | Facility |
|---|---|---|
| Detroit, MI | Unavailable | Unavailable |
| Rest of Michigan | Unavailable | Unavailable |
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
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
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J9356 isn’t priced in this setting.
J9356 compared with similar codes
Compare codes · National
4 codes, side by side
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.
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
Fee sheets · Coming soon
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