HCPCS
J9042
1 mg = 1 unit
Phase 1
Identify what you're billing
Adcetris dose varies sharply by regimen — confirm the indication first.
Dosing by regimen FDA label verified May 2026
Adcetris is approved across 6+ regimens, each with its own mg/kg dose, schedule, and cycle count. Get the regimen right before computing units.
| Regimen | Indication | Dose | Schedule | Cycles | Combo agents |
|---|---|---|---|---|---|
| A+AVD | 1L stage III/IV cHL (ECHELON-1) | 1.2 mg/kg | q2w | 12 cycles (6 mo) | + doxorubicin, vinblastine, dacarbazine (replaces bleomycin in ABVD) |
| A+CHP | 1L sALCL / CD30+ PTCL (ECHELON-2) | 1.8 mg/kg | q3w | 6–8 cycles | + cyclophosphamide, doxorubicin, prednisone (replaces vincristine in CHOP) |
| Brentuximab + nivolumab | R/R cHL | 1.8 mg/kg | q3w | Per protocol | + Opdivo (J9299) 240 mg q2w/q3w |
| Monotherapy — R/R cHL post-ASCT | cHL post-autologous stem cell transplant or post-≥2 prior multi-agent regimens | 1.8 mg/kg | q3w | Max 16 cycles | None |
| Monotherapy — R/R sALCL | sALCL after ≥1 prior multi-agent regimen | 1.8 mg/kg | q3w | Max 16 cycles | None |
| CTCL | pcALCL or CD30+ MF post-prior systemic therapy | 1.8 mg/kg | q3w | Per response | None |
| Pediatric cHL (AHOD1331) | cHL stage IIB high-risk + III/IV, age ≥2 yr (added 2022) | 48 mg/m² | q2w | 5 cycles | + AVE-PC (modified ABVE-PC) |
Worked examples — unit math by regimen (80 kg adult)
# A+AVD — 1.2 mg/kg q2w × 12 cycles, 80 kg patient
Per-dose mg: 80 × 1.2 = 96 mg → bill 96 units of J9042
Vials needed: 2 × 50 mg = 100 mg total, 4 mg waste → bill JW for 4 units
Total cycles: 12; total drug units billed: 1,152 (96 × 12)
Total course cost (Q2 2026 ASP+6%): ~$309,573 (drug only)
# A+CHP — 1.8 mg/kg q3w × 6 cycles, 80 kg patient
Per-dose mg: 80 × 1.8 = 144 mg → bill 144 units of J9042
Vials needed: 3 × 50 mg = 150 mg total, 6 mg waste → bill JW for 6 units
Total cycles: 6; total drug units billed: 864 (144 × 6)
Total course cost (Q2 2026 ASP+6%): ~$232,180 (drug only)
# Monotherapy R/R cHL — 1.8 mg/kg q3w × 16 max, 80 kg patient
Per-dose mg: 144 mg → bill 144 units of J9042 + 6 JW
Total max cycles: 16; max drug units: 2,304
Total max course cost (Q2 2026 ASP+6%): ~$619,148 (drug only)
Per-dose mg: 80 × 1.2 = 96 mg → bill 96 units of J9042
Vials needed: 2 × 50 mg = 100 mg total, 4 mg waste → bill JW for 4 units
Total cycles: 12; total drug units billed: 1,152 (96 × 12)
Total course cost (Q2 2026 ASP+6%): ~$309,573 (drug only)
# A+CHP — 1.8 mg/kg q3w × 6 cycles, 80 kg patient
Per-dose mg: 80 × 1.8 = 144 mg → bill 144 units of J9042
Vials needed: 3 × 50 mg = 150 mg total, 6 mg waste → bill JW for 6 units
Total cycles: 6; total drug units billed: 864 (144 × 6)
Total course cost (Q2 2026 ASP+6%): ~$232,180 (drug only)
# Monotherapy R/R cHL — 1.8 mg/kg q3w × 16 max, 80 kg patient
Per-dose mg: 144 mg → bill 144 units of J9042 + 6 JW
Total max cycles: 16; max drug units: 2,304
Total max course cost (Q2 2026 ASP+6%): ~$619,148 (drug only)
Dose capping
For patients weighing more than 100 kg, calculate the dose using actual body weight up to 100 kg. Maximum dose: 120 mg per dose (1.2 mg/kg cap) for A+AVD; 180 mg per dose (1.8 mg/kg cap) for 1.8 mg/kg regimens. Document weight in the chart for audit.
Reconstitution & infusion
- Reconstitute each 50 mg vial with 10.5 mL sterile water for injection → 5 mg/mL solution
- Withdraw calculated dose volume; further dilute in 0.9% NaCl, 5% Dextrose, or LR (final 0.4–1.8 mg/mL)
- Infuse over 30 minutes through a dedicated IV line
- Do NOT administer as IV push or bolus
- Stable refrigerated 24 hours after reconstitution; use immediately for best stability
ADC class comparison — Adcetris vs other antibody-drug conjugates FDA verified May 2026
Six FDA-approved ADCs in oncology share architecture (mAb + linker + cytotoxic payload) but vary by target, payload chemistry, and indication.
| ADC | HCPCS | Target | Payload | Lead indication | Class context |
|---|---|---|---|---|---|
| Adcetris | J9042 |
CD30 | MMAE (auristatin) | cHL, sALCL, PTCL, CTCL | Original FDA-approved ADC (2011 accelerated, 2017 full) |
| Polivy | J9309 |
CD79b | MMAE (auristatin) | DLBCL (Pola-R-CHP, R/R DLBCL) | Same payload as Adcetris, different B-cell target |
| Padcev | J9177 |
Nectin-4 | MMAE (auristatin) | Urothelial carcinoma | Same payload as Adcetris, solid-tumor target |
| Tivdak | J9273 |
Tissue factor | MMAE (auristatin) | Cervical cancer (R/R) | Same payload as Adcetris, different solid-tumor target |
| Enhertu | J9358 |
HER2 | Deruxtecan (DXd, topoisomerase I inhibitor) | HER2+ breast, gastric, NSCLC | Different payload chemistry; pneumonitis warning |
| Trodelvy | J9317 |
Trop-2 | Govitecan (SN-38, topoisomerase I inhibitor) | TNBC, HR+/HER2- breast, urothelial | Different payload chemistry; severe diarrhea/neutropenia |
Why this matters for billing: ADCs are heterogeneous. MMAE-payload ADCs (Adcetris, Polivy, Padcev,
Tivdak) share peripheral neuropathy as a class effect. Deruxtecan-payload Enhertu has interstitial lung disease
as the signature toxicity. SN-38 (govitecan) ADCs trigger severe diarrhea. Each has its own J-code, ICD-10 set,
and prior-auth criteria — do not assume billing parity across the ADC class.
Combo with checkpoint inhibitors: Adcetris + Keytruda (J9271) and
Adcetris + Opdivo (J9299) have been studied in R/R cHL. Verify per-payer policy
before billing the combo — some payers reject the IO portion if Adcetris is the labeled monotherapy
regimen.
Peripheral neuropathy — dose-limiting AE FDA label verified May 2026
Peripheral neuropathy occurs in ~67% of patients (predominantly sensory) and is the
dose-limiting toxicity of the MMAE payload. New or worsening neuropathy may require dose modification or
permanent discontinuation. Document neurologic exam at each cycle for audit and dose-modification justification.
Dose modifications for neuropathy (per label)
- Grade 1–2 new or worsening: continue current dose
- Grade 2 worsening / Grade 3 new: hold until ≤Grade 2, then resume at reduced dose (1.2 mg/kg if on 1.8 mg/kg; 0.9 mg/kg if on 1.2 mg/kg)
- Grade 4: permanently discontinue Adcetris
Document the discontinuation in the chart; if the patient returns to therapy after a partial recovery, the reduced-dose claim line is straightforward (bill actual mg administered). Payers do not require a separate PA for routine dose reductions, but some require notification within 30 days.
NDC reference FDA NDC Directory verified May 2026
| NDC (10 / 11-digit) | Package | Use |
|---|---|---|
51144-050-01 / 51144-0050-01 |
50 mg lyophilized single-dose vial — 1 vial per carton | All adult and pediatric Adcetris dosing |
Single SKU, weight-based dose — waste is the norm. The 50 mg vial size combined with
1.2 or 1.8 mg/kg dosing virtually guarantees partial-vial waste on every adult claim. Bill JW for the
discarded portion. CMS audits flag claims missing the JW line.
Use the carton-level NDC. Submit
51144-050-01 (10-digit) or
51144-0050-01 (11-digit, N4-qualified) on box 24A shaded area of the CMS-1500. Do not submit
Pfizer / Seagen labeler-only NDC fragments.
Phase 2
Code the claim
Chemotherapy admin codes apply (ADC = complex monoclonal antibody-cytotoxic conjugate).
Administration codes CPT verified May 2026
Adcetris is billed under chemotherapy administration codes. Combo regimens (A+AVD, A+CHP) require sequencing 96413 + 96417 across the multi-drug infusion.
| Code | Description | When to use |
|---|---|---|
96413 |
Chemotherapy administration, IV infusion technique; up to 1 hour, single or initial substance/drug | Primary code for Adcetris. 30-min standard infusion fits within the 1-hour window. |
96415 |
Chemotherapy administration, IV infusion; each additional hour | Rarely needed for monotherapy. Pair with 96413 if combined infusions extend beyond 1 hour. |
96417 |
Chemotherapy administration, IV infusion technique; each additional sequential infusion (different drug or substance) | For A+AVD, A+CHP combo regimens. Use 96413 for first agent, 96417 for each subsequent agent in the same encounter. |
96365 / 96366 |
Therapeutic IV infusion (non-chemo) | NOT appropriate. Adcetris is an ADC with cytotoxic MMAE payload — bills under chemo admin codes per AMA classification. |
Combo sequencing tip (A+CHP, A+AVD): bill 96413 for the first IV chemo agent infused, 96417
for each additional sequential drug, and 96411 (chemo IV push) for any single-push agents. Document infusion
start/stop times for each drug in the chart — payers may audit.
Modifiers CMS verified May 2026
JZ + JW — almost always both
Adcetris is a fixed 50 mg single-dose vial with weight-based dosing — the math virtually never lands on
a clean 50 mg multiple. Bill JZ on the units administered and JW on the discarded
units on a separate claim line. Example: 80 kg patient on 1.8 mg/kg = 144 mg administered
(3 vials, 150 mg total) → bill 144 units with JZ and 6 units with JW.
One of JZ or JW must be on every J9042 claim per CMS's July 2023 single-dose container policy. Missing the modifier triggers automatic denial.
Modifier 25 — same-day E/M
Use modifier 25 on the E/M code when a significant, separately identifiable evaluation and management service is performed on the same day as the infusion. Routine pre-infusion clinical assessment is bundled.
340B modifiers (JG, TB)
For 340B-acquired Adcetris, follow your MAC's current 340B modifier policy. Pfizer's billing guide does not provide 340B-specific instructions.
ICD-10-CM by indication group FY2026 verified May 2026
Adcetris covers four lymphoma families. Use the most specific code supported by encounter documentation; pair with Z51.11 on the admin claim.
| Indication | ICD-10 family | Specific codes (high-frequency) | Notes |
|---|---|---|---|
| Hodgkin lymphoma (cHL) | C81.x |
C81.10–C81.19 nodular sclerosis; C81.20–C81.29 mixed cellularity; C81.30–C81.39 lymphocyte-depleted; C81.40–C81.49 lymphocyte-rich; C81.70–C81.79 other; C81.90–C81.99 unspecified |
5th character = anatomic site of nodes (0=unspec, 1=head/neck, 2=intrathoracic, 3=intra-abdominal, 4=axilla/upper limb, 5=inguinal/lower limb, 6=intrapelvic, 7=spleen, 8=multiple sites, 9=extranodal) |
| Anaplastic large cell lymphoma (sALCL) | C84.6x / C84.7x |
C84.60–C84.69 ALCL ALK-positive; C84.70–C84.79 ALCL ALK-negative |
For 1L A+CHP (ECHELON-2) and R/R sALCL monotherapy |
| Peripheral T-cell lymphoma (PTCL NOS) | C84.4x |
C84.40–C84.49 PTCL NOS by site |
For 1L A+CHP (ECHELON-2). CD30 IHC documentation required for PA in some payers. |
| CTCL — mycosis fungoides | C84.0x |
C84.00–C84.09 MF by site |
CD30+ MF post-prior systemic therapy. CD30 IHC (CPT 88341/88342) required by most payers. |
| CTCL — primary cutaneous ALCL | C84.A |
C84.A0–C84.A9 pcALCL by site |
Post-prior systemic therapy. CD30 IHC documentation expected. |
| Sézary syndrome (CTCL variant) | C84.1x |
C84.10–C84.19 Sézary by site |
Off-label in some payers; verify before submitting. |
| Encounter for chemotherapy | Z51.11 |
Z51.11 Encounter for antineoplastic chemotherapy |
Pair with primary cancer diagnosis code on every admin claim line. |
CD30 IHC documentation is the most common PA gap. CPT 88341 (each additional single antibody)
/ 88342 (initial single antibody) for CD30 IHC must be on file at the same encounter (or reference a prior
result) for CTCL and PTCL indications. Schedule CD30 IHC BEFORE submitting the Adcetris PA.
Indication-specific PA criteria are the norm. Most payers require ICD-10, prior therapies,
line of therapy, AND CD30 IHC results for CTCL/PTCL. ICD-10 alone is not sufficient.
Site of care & place of service Verified May 2026
UnitedHealthcare and Aetna run site-of-care UM for Adcetris in the same way they do for monoclonal antibodies and ADCs broadly — preferring office/AIC over hospital outpatient after the first cycle of any regimen. Combo regimens (A+AVD, A+CHP) often warrant initial HOPD administration for the chemo backbone but transition to office or AIC by cycle 2–3 if clinically stable.
| Setting | POS | Claim form | Payer steering |
|---|---|---|---|
| Physician oncology office | 11 | CMS-1500 / 837P | Preferred for monotherapy and post-cycle-1 combo |
| Ambulatory infusion suite (AIC) | 49 | CMS-1500 / 837P | Preferred for combo regimens |
| Oncology ASC | 24 | CMS-1500 / 837P | Acceptable |
| Hospital outpatient (on-campus) | 22 | UB-04 / 837I | Disfavored after cycle 1–3 |
| Hospital outpatient (off-campus PBD) | 19 | UB-04 / 837I | Disfavored after cycle 1–3 |
| Patient home | 12 | CMS-1500 (with home infusion) | Rare for ADCs; verify per payer |
Claim form field mapping Pfizer 2025
From Pfizer Oncology Together HCP coding & coverage guide.
| Information | CMS-1500 box | Notes |
|---|---|---|
| NPI | 17b | Rendering provider |
| NDC qualifier + 11-digit NDC + UoM + qty | 24A shaded area | N4 + 51144-0050-01 + ML + total volume reconstituted |
| HCPCS J9042 + JZ (administered units) | 24D (drug line 1) | Mark JZ on the administered mg |
| HCPCS J9042 + JW (waste units) | 24D (drug line 2) | Separate line for discarded mg from partial vial |
| Drug units | 24G | Actual mg administered (line 1) + waste mg (line 2) |
| CPT 96413 (admin line) | 24D (admin line) | Primary chemo admin code (30-min infusion) |
| CPT 96417 (combo additional sequential) | 24D (admin line, A+AVD/A+CHP only) | Each subsequent agent in combo regimen |
| ICD-10 | 21 | Primary cancer code (C81.x / C84.x family) + Z51.11 |
| CD30 IHC test claim line (if applicable) | 24D | CPT 88341 / 88342 (CTCL, PTCL indications) |
| PA number | 23 | Required by all major payers |
Phase 3
Get paid
CD30 IHC, regimen documentation, and PML monitoring are the hard prerequisites.
Payer policy snapshot Reviewed May 2026
All major payers require PA. Indication-specific documentation (stage, line of therapy, prior regimens, CD30 IHC) is the gating issue.
| Payer | PA? | Documentation focus | Site-of-care UM |
|---|---|---|---|
| UnitedHealthcare Oncology Medication Clinical Coverage Policy |
Yes | Stage III/IV cHL for ECHELON-1 (A+AVD); CD30 IHC for CTCL/PTCL; pathology confirmation for sALCL | Yes — Optum-managed steering away from HOPD post-cycle 1–3 |
| Aetna CPB + Medical Drug policies |
Yes | Aligned with NCCN Hodgkin / T-Cell Lymphoma guidelines; CD30 IHC for CTCL | Yes (separate Site-of-Care policy applies) |
| BCBS plans Vary by plan |
Yes | Generally NCCN-aligned; CD30 IHC required for CTCL/PTCL | Plan-specific; most have ADC site-of-care steering |
| Medicare (MAC LCDs) | Generally yes for HOPD; varies by MAC | Coverage for label indications; LCDs follow FDA label + NCCN | HOPD packaging rules apply (no separate site-of-care UM) |
Step therapy
Generally NOT required for FDA-labeled 1L indications (A+AVD ECHELON-1, A+CHP ECHELON-2). For CTCL, some payers require prior systemic therapy failure. For R/R sALCL or R/R cHL, the prior multi-agent regimen requirement is satisfied by the indication itself.
NCCN alignment
Adcetris is NCCN Category 1 (preferred) for most labeled indications: 1L stage III/IV cHL (A+AVD), 1L PTCL/sALCL (A+CHP), R/R cHL post-ASCT, R/R sALCL, and CD30+ CTCL post-systemic. Cite NCCN compendium (Hodgkin Lymphoma + T-Cell Lymphoma guidelines) on PA submissions where indicated.
Medicare reimbursement CMS Q2 2026 (live)
Quarterly ASP from CMS Part B Drug Pricing File. Refreshes automatically each quarter.
Q2 2026 payment snapshot — J9042
Effective April 1 – June 30, 2026 · Based on 4Q25 ASP submissions
ASP + 6%
$268.727
per mg / per unit
96 mg dose (1.2 mg/kg, 80 kg)
$25,797.79
96 units × ASP+6%
144 mg dose (1.8 mg/kg, 80 kg)
$38,696.69
144 units × ASP+6%
Course-level cost (drug only, Q2 2026 ASP+6%, 80 kg patient):
A+AVD 12 cycles ≈ $309,573;
A+CHP 6 cycles ≈ $232,180;
Monotherapy R/R cHL up to 16 cycles ≈ $619,148.
After ~2% sequestration: ~ASP+4.3% actual paid.
Coverage
No NCD specific to brentuximab vedotin. Coverage falls under MAC LCDs for biologics + the generic drug-coverage framework. All MACs cover J9042 for FDA-approved on-label indications with appropriate ICD-10 and pathology documentation.
Code history
- J9042 — permanent code "Brentuximab vedotin inj"; effective shortly after FDA accelerated approval (August 2011); pre-permanent-code period used unclassified J3490.
Patient assistance — Pfizer Oncology Together Pfizer verified May 2026
- Pfizer Oncology Together: 1-877-744-5675 / pfizeroncologytogether.com — benefits investigation, prior authorization assistance, appeals support, nurse counseling
- Adcetris Co-Pay Card: commercial copay support; eligible commercially-insured patients (excludes Medicare, Medicaid, federal program patients); first dose may be $0
- Pfizer Patient Assistance Foundation: free product for uninsured / underinsured patients meeting income requirements
- Foundations: for Medicare patients, refer to Patient Advocate Foundation, HealthWell, CancerCare, LLS — verify open lymphoma funds quarterly
- Web: adcetris.com / pfizeroncologytogether.com
Need to model what a specific patient will actually pay after copay assistance, deductible, coinsurance, and
OOP max? Run a CareCost Estimate — J9042 pre-loaded.
Phase 4
Fix problems
PML monitoring, JW omission, and CD30 IHC gaps are the recurring failures.
PML & safety monitoring FDA boxed warning verified May 2026
BOXED WARNING — Progressive Multifocal Leukoencephalopathy (PML). Rare, serious, sometimes
fatal opportunistic JC virus brain infection. Cases have been reported in Adcetris-treated patients, often
with prior or concurrent immunosuppressive therapies.
- Monitor for new-onset or worsening neurologic, cognitive, or behavioral signs/symptoms
- Hold Adcetris and initiate workup (MRI, CSF JCV PCR, neurology consult) if PML suspected
- Permanently discontinue if PML is confirmed
Other significant warnings & precautions
- Peripheral neuropathy: ~67% of patients (predominantly sensory); dose-limiting MMAE-payload class effect — see section above
- Severe infusion reactions / anaphylaxis: stop infusion; manage per institutional protocol; pre-medicate subsequent infusions
- Neutropenia: severe (Grade 3–4) in ~24% of patients; G-CSF prophylaxis recommended in A+AVD and A+CHP per NCCN
- Tumor lysis syndrome: risk in patients with bulky disease or rapidly proliferating tumors; monitor electrolytes, uric acid, renal function pre-cycle 1
- Hepatotoxicity: serious cases reported; monitor LFTs; hold or discontinue based on grade
- Hyperglycemia: reported, especially in patients with elevated BMI or diabetes; monitor glucose
- GI events: pancreatitis (fatal cases), serious bowel events including perforation; evaluate severe abdominal pain promptly
- Pulmonary toxicity: non-infectious pulmonary toxicity reported; monitor for new or worsening pulmonary symptoms
- Embryo-fetal toxicity: can cause fetal harm; verify pregnancy status; counsel on contraception
Common denials & how to fix them
| Denial reason | Common cause | Fix |
|---|---|---|
| JW missing | Single 50 mg vial billed for weight-based dose without reporting waste | Add JW line for discarded units. JZ on administered units; JW on wasted units. Required on virtually every adult Adcetris claim. |
| JZ missing | Single-dose vial claim without JZ | Resubmit with JZ on the administered-units line. Required since 7/1/2023. |
| CD30 IHC not documented | CTCL or PTCL PA submitted without CD30 immunohistochemistry result | Submit CD30 IHC test result (CPT 88341/88342) + retroactive PA. Schedule CD30 IHC BEFORE Adcetris PA for these indications. |
| Wrong admin code (96365) | Therapeutic IV billed instead of chemo IV | Resubmit with 96413. Adcetris is an ADC with cytotoxic MMAE payload — chemo admin per CPT classification. |
| Combo sequencing not documented | A+AVD or A+CHP billed without 96417 for sequential agents | Add 96417 for each subsequent agent; document infusion start/stop times for each drug in the chart. |
| Stage / line-of-therapy not documented | ECHELON-1 (A+AVD) billed without stage III/IV documentation | Submit pathology + imaging staging documentation. ECHELON-1 indication is restricted to stage III/IV cHL. |
| Wrong NDC format | Vial-level NDC submitted instead of carton NDC | Use carton NDC: 51144-050-01 (10) / 51144-0050-01 (11). |
| Site of care (HOPD) | HOPD administration after cycle 1–3 on commercial plan with site-of-care UM | Move to office (POS 11) or AIC (POS 49). Submit medical necessity letter if HOPD required for clinical reasons. |
| Step therapy in CTCL | Adcetris PA submitted in CTCL without prior systemic therapy documentation | Submit prior systemic therapy history (bexarotene, methotrexate, IFN, etc.). CTCL indication requires post-prior-systemic-therapy. |
| Pediatric m² dosing flagged | Adult mg/kg dose billed for pediatric patient (or vice versa) | Pediatric AHOD1331 protocol uses 48 mg/m² q2w. Document BSA calculation in chart; bill actual mg administered. |
Frequently asked questions
What is the HCPCS code for Adcetris?
Adcetris (brentuximab vedotin) is billed under HCPCS J9042 — "Brentuximab vedotin inj."
Each milligram equals one billable unit. Adcetris was the first FDA-approved antibody-drug conjugate
(accelerated approval August 2011, full approval 2017). It is supplied as a 50 mg lyophilized single-dose vial
reconstituted with 10.5 mL sterile water to 5 mg/mL.
How do I bill A+AVD vs A+CHP regimens?
A+AVD (ECHELON-1, 1L stage III/IV cHL): 1.2 mg/kg IV every 2 weeks for 12 cycles, replacing
bleomycin in ABVD. A+CHP (ECHELON-2, 1L PTCL/sALCL): 1.8 mg/kg IV every 3 weeks for 6–8
cycles, replacing vincristine in CHOP. Both bill J9042 at the actual mg administered (weight-based
dosing produces JW waste from fixed 50 mg vials). Combo agents bill under their own J-codes on separate lines;
admin uses 96413 for the first IV agent and 96417 for each subsequent sequential agent.
What administration CPT do I use for Adcetris?
CPT 96413 — "Chemotherapy administration, IV infusion technique; up to 1 hour, single or
initial substance/drug." Adcetris is an ADC with cytotoxic MMAE payload and bills under chemo admin codes.
Standard infusion is 30 minutes, fitting within the 1-hour 96413 window. For combo regimens, add 96417 for each
subsequent sequential agent.
Do I bill JZ or JW for Adcetris?
Both, on virtually every adult claim. Adcetris is supplied as fixed 50 mg single-dose vials
but dosed by weight (1.2 mg/kg or 1.8 mg/kg). Almost every adult dose produces partial-vial waste. Bill
JZ on the units administered and JW on the discarded units on a separate claim line.
Example: 80 kg patient on 1.8 mg/kg = 144 mg, three 50 mg vials (150 mg) → 144 units JZ + 6 units JW.
One of JZ or JW must be on every J9042 claim per CMS's July 2023 single-dose container policy.
What is the Medicare reimbursement for J9042?
For Q2 2026, the Medicare Part B payment limit for J9042 is $268.727 per mg (ASP + 6%). For an 80 kg patient at 1.8 mg/kg (144 mg dose), reimbursement is approximately $38,696.69 per infusion. For A+AVD (1.2 mg/kg q2w × 12 cycles), 80 kg patient = 96 mg/dose ≈ $25,797.79/dose × 12 = ~$309,573 total course (drug only). Sequestration (~2%) reduces actual paid to roughly ASP + 4.3%.
What is the boxed warning for Adcetris?
BOXED WARNING: Progressive multifocal leukoencephalopathy (PML) — a rare, serious, sometimes fatal opportunistic infection of the brain caused by JC virus reactivation. Risk is increased with prior or concurrent immunosuppressive therapies. Monitor for new-onset or worsening neurologic, cognitive, or behavioral signs and symptoms. Withhold Adcetris if PML is suspected, and permanently discontinue if PML is confirmed. Other significant warnings include peripheral neuropathy (~67% of patients, dose-limiting), severe infusion reactions, neutropenia (severe in 24%), tumor lysis syndrome, and hepatotoxicity.
How does Adcetris compare to other antibody-drug conjugates?
Adcetris (J9042, anti-CD30, MMAE payload) is the original FDA-approved ADC and the workhorse cHL drug. Polivy (J9309, anti-CD79b for DLBCL), Padcev (J9177, anti-Nectin-4 for urothelial), and Tivdak (anti-tissue-factor for cervical) share the same MMAE payload but target different antigens. Enhertu (J9358, anti-HER2) uses the deruxtecan (DXd) payload — different chemistry, different toxicity profile (ILD). Trodelvy (J9317, anti-Trop-2) uses the govitecan (SN-38) payload. Same class, different antigens and payloads drive different billing and toxicity profiles.
What ICD-10 codes are appropriate for Adcetris?
Hodgkin lymphoma uses C81.x (e.g., C81.10–C81.99 by histology + site). Anaplastic large
cell lymphoma uses C84.6x (ALK-positive) or C84.7x (ALK-negative). Peripheral T-cell
lymphoma NOS uses C84.4x. CTCL: mycosis fungoides C84.0x, primary cutaneous ALCL
C84.A, Sézary C84.1x. Pair with Z51.11 (encounter for chemo) on
the admin claim line.
Reference
Sources & methodology
Every claim on this page is sourced. Methodology and review history below.
Source documents
- FDA — ADCETRIS prescribing information (BLA 125388)
- DailyMed — ADCETRIS (brentuximab vedotin)
- Pfizer Oncology Together — Adcetris Coding & Coverage HCP page
- CMS — Medicare Part B Drug ASP Pricing File
- SEER CanMED — HCPCS J9042 reference
- UnitedHealthcare — Oncology Medication Clinical Coverage Policy
- Aetna CPB — Oncology medical drugs (covers Adcetris)
- NCCN — Hodgkin Lymphoma Guidelines
- NCCN — T-Cell Lymphomas Guidelines
- Adcetris HCP / patient site
- FDA National Drug Code Directory
About this page
We maintain this page as a living reference. Medicare ASP pricing is bound to our underlying CareCost data layer and refreshes automatically when CMS publishes new quarterly files. Coding and policy content is reviewed at least quarterly and updated whenever a source document changes.
Found an error? Email hello@carecostestimate.com.
Refresh cadence
| Element | Cadence | How it's refreshed |
|---|---|---|
| Medicare ASP pricing | Quarterly | Auto-bound to CareCost ASP layer; updates on CMS file release. |
| Payer policies (UHC, Aetna, BCBS) | Semi-annual | Manual review against published payer policy documents. |
| HCPCS / CPT / modifier rules + biomarker test codes | Annual | Reviewed against CMS HCPCS quarterly files, AMA CPT releases, and AMA Category III code updates. |
| NDC, dosing, FDA label, indication list | Event-driven | Tied to manufacturer document version + FDA label revision date. |
Reviewer
Pending SME review. This page is staff-authored from primary sources (FDA, CMS, manufacturer,
payer documents — all linked above). Editorial review in progress.
Until that review is complete, treat this as a draft reference and verify each cited source for high-stakes
claims.
Change log
- — Initial publication. ASP data: Q2 2026. Manufacturer source: Pfizer 2025 (post-Seagen acquisition). FDA label: most recent revision (incl. pediatric cHL 2022 addition; ECHELON-1/ECHELON-2 expanded follow-up). Six labeled regimens covered. PML boxed warning prominent. ADC class context: original FDA-approved ADC (2011 accelerated, 2017 full).
Methodology
Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File. Payer policies are read directly from each payer's published medical/pharmacy policy documents. Indication list is verified against the current FDA label revision and NCCN compendium. We do not paraphrase from billing-software vendor blogs.