## **What is the HCPCS code J9354 for?**
The HCPCS code J9354 is meant to denote the injection of the medicine called ado-trastuzumab emtansine, specifically a 1 mg dosage of it. This medicine was created to help patient's fight off certain types of breast cancer. The goal of this medicine is to eliminate cancer cells while minimizing the damage done to the body's healthy cells.
For patients who have a type of breast cancer that doesn't respond to other prior therapies (HER2-related) and chemotherapy drugs, and for those who have HER2-positive metastatic breast cancer, this medicine is another option, or it can become the primary procedure for them moving forward if the results have been great.
The injection of this medicine is done so intravenously, so this requires a sterile IV infusion line and infusion pump to administer.
The expected outcomes of using this medicine include:
- Slower cancer progression
- Shrinking of tumors
- Prolonged life expectancy of the patient
- Improved quality of life
- Relief from breast cancer symptoms
## **Documentation requirements for J9354**
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 + their credentials
- The name and address of the facility where the injection was administered
- The full name of the patient
- The patient's consent
- The medical necessity
- The date and time of the drug administration by IV injection (including the duration of the infusion)
- Patient records showing they have been diagnosed with an HER2-positive breast cancer (metastatic or otherwise)
- Patient records showing prior treatment history
- Patient records showing results of a cardiac function test (ECHO or MUGA scan results should suffice)
- Imaging test results showing locations and sizes of the malignant neoplasms
- The exact dosage and route
## **Billing requirements for J9354**
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 use the CPT code 96365 since this injection is an intravenous injection.
Remember, you have to bill per 1 mg administered.
Frequently asked questions
