HCPCS Code J9316: Injection, Pertuzumab, Trastuzumab, and Hyaluronidase-zzxf, Per 10 mg

Learn about the HCPCS code J9316 for injection, pertuzumab, trastuzumab, and hyaluronidase-zzxf, per 10 mg through this guide.

Use Code

## **What is the HCPCS code J9316 for?** The HCPCS code J9316 is for the injection of pertuzumab, trastuzumab, and hyaluronidase-zzxf in one go, specifically per dosage of 10 mg. This is more commonly called an HER2-targeted therapy injection. This triple combination of medicine is injected subcutaneously. Its purpose is to treat HER2-positive breast cancer (e.g., early stage breast cancer, locally advanced/metastatic breast cancer). What this medicine does is it slows or stops the continued growth and proliferation of breast cancer cells (which is great for those with early breast cancer, or at least signs of it). It can also shrink tumors, which is great if the patient will undergo breast cancer surgery. It can also reduce the chances of the cancer from emerging again even after successful treatments in the past. For (adult) patients with advanced stages of cancer, this injection can at least manage the symptoms. This code's effective date is January 1, 2021. It's still ongoing.

## **Documentation requirements for J9316** As with any procedure, especially involving injecting drugs into patients, it's important to document the following before you file for a claim that includes this code: - The full name of the personnel who administered the injection and their credentials - The name and address of the facility where the injection was administered - The full name of the patient - The dates and times of the drug administration by injection (for the initial dose/loading dose and subsequent visits) - Patient records showing they have been diagnosed with HER2-positive breast cancer - Blood test results and imaging studies that give a picture of the patient's overall health - Complete treatment regimen for the patient - Imaging test results showing locations and sizes of tumors, and if there is a metastatic disease and if the patient is node positive - The exact dosages given each time the patient received injections Documentation should support medical necessity and align with oncology treatment guidelines.

## **Billing requirements for J9316** Besides the documentation requirements above, please note the following billing requirements for this HCPCS code: - They must reflect the dosage given over the course of the treatment. - Use either of two modifiers: JW if there's unused medication in a vial (wastage), or JZ if there's no unused medication. Please ensure to use the CPT code 96372, which is meant for the administration of medicine via injection intramuscularly or subcutaneously.

## **Other similar codes** - J9309 - Injection, polatuzumab vedotin-piiq, 1 mg - J9311 - Injection, rituximab 10 mg and hyaluronidase - J9312 - Injection, rituximab, 10 mg - J9313 - Injection, moxetumomab pasudotox-tdfk, 0.01 mg - J9314 - Injection, pemetrexed (Teva) not therapeutically equivalent to J9305, 10 mg

Frequently asked questions

Chemotherapy drugs, intravenous pertuzumab, intravenous trastuzumab, adjuvant treatment/adjuvant therapy, neoadjuvant treatment, and other targeted therapies.

It's common to feel pain or discomfort in the injection site and for redness and slight swelling to be present. The possible high-risk complications include allergic reactions, cardiac issues, and respiratory problems.

It should be done in 10 minutes, including preparation.