## **What is the HCPCS code J9306 for?**
The HCPCS code J9306 is meant to designate the provision of a pertuzumab injection, specifically a 1 mg dosage of it.
This type of injection is used to treat certain types of breast cancer (e.g., HER2-positive breast cancer, early breast cancer, metastatic breast cancer, inflammatory breast cancer, etc.). Please note that this isn't necessarily a chemotherapy drug on its own despite being a treatment for cancer.
What this injection does is to slow down or totally halt the progress and growth of the cancer, and reduce the size of malignant neoplasms, all of which can extend the life expectancy of the patient and improve their quality of life.
This injection is only viable if the patient hasn't responded well to other treatment options. Also, it's usually given in combination with other drugs like trastuzumab and docetaxel.
## **Documentation requirements for J9306**
As with any HCPCS code, it's important to have sufficient documentation that meets the coding guidelines of your insurer, along with related policy articles and local coverage determinations. Here are examples of what you need:
- The full name of the patient
- The full names and credentials of the healthcare professionals who handled the patient
- The name and address of the facility where the injection was administered
- Relevant information and indications tied to the patient's condition (e.g., diagnosis, blood test results, imaging tests showing size and location of tumors, etc.) to determine and justify medical necessity
- Drug information (e.g., drug name, route of administration, lot number, manufacturer, National - - - Drug Code, expiration date, etc.)
- Start and stop times of the injection, especially if it was done intravenously
- Provider order
## **Billing requirements for J9306**
Besides the documentation requirements above, please take note of or have the following:
- 1 mg = 1 unit
- An appropriate ICD code based on your patient's condition
- The appropriate CPT code based on the route of administration (e.g., CPT 96413 - Chemotherapy, IV infusion, up to 1 hour; CPT 96415 - Each additional hour if infusion continues)
- Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication.
- Place of service: outpatient hospital, infusion center, physician's office, etc.
## **Other similar codes**
- **J9271** - Injection, pembrolizumab, 1 mg
- **J9309** - Injection, polatuzumab vedotin-piiq, 1 mg
- **J9354** - Injection, ado-trastuzumab emtansine, 1 mg
- **J9267** - Injection, paclitaxel, 1 mg
- **J3262** - Injection, tocilizumab, 1 mg
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