Adcetris (brentuximab vedotin) — HCPCS J9042
CareCost Estimate · Billing Cheat Sheet
Pfizer (Seagen)
50 mg lyophilized single-dose vial
IV infusion 30 min
Reviewed: May 2, 2026
ASP: Q2 2026
Std dose
1.8 mg/kg
q3w mono / A+CHP
Modifier
JZ + JW
50 mg vial / weight-based
Admin CPT
96413
Chemo IV (30 min)
Medicare ASP+6%
$268.727
/mg · ~$38,697 / 144 mg
BOXED WARNING — PML: Progressive multifocal leukoencephalopathy (JC virus). Rare, sometimes fatal. Increased risk with prior/concurrent immunosuppressives. Monitor neuro signs; permanently d/c if PML confirmed.
Codes & NDC
| HCPCS | J9042 — "Brentuximab vedotin inj" (permanent) |
|---|
| NDC | 51144-050-01 (10) / 51144-0050-01 (11) — N4 qualifier |
|---|
| Vial | 50 mg lyo SDV; reconstitute w/ 10.5 mL SWFI → 5 mg/mL |
|---|
| Approval | Aug 2011 (accel, BLA 125388); full 2017; pediatric cHL 2022 |
|---|
| Benefit | Medical (provider buy-and-bill) |
|---|
Dosing by regimen
| Regimen | Dose | Cycles |
|---|
| A+AVD (1L stage III/IV cHL) | 1.2 mg/kg q2w | 12 |
| A+CHP (1L PTCL/sALCL) | 1.8 mg/kg q3w | 6–8 |
| + Opdivo R/R cHL | 1.8 mg/kg q3w | per protocol |
| Mono R/R cHL post-ASCT | 1.8 mg/kg q3w | max 16 |
| Mono R/R sALCL | 1.8 mg/kg q3w | max 16 |
| CTCL (CD30+) | 1.8 mg/kg q3w | per response |
| Pediatric cHL (AHOD1331) | 48 mg/m² q2w | 5 |
Dose cap: use actual body weight up to 100 kg. Max 120 mg (1.2 mg/kg) / 180 mg (1.8 mg/kg).
Administration & modifiers
| Code | When |
|---|
96413 | Chemo IV, 1 hr (primary) |
96417 | Each addl sequential drug (A+AVD, A+CHP) |
96415 | Each addl hr (rare for mono) |
96365 | NOT appropriate — Adcetris is chemo admin (ADC w/ MMAE payload) |
JZ + JW on same claim: 50 mg fixed vial + weight-based dose = waste on virtually every adult claim. JZ on administered units; JW on discarded units (separate line). Required since 7/1/2023.
Worked example (80 kg)
- A+CHP 1.8 mg/kg: 144 mg administered (3 vials = 150 mg)
- Bill J9042 × 144 + JZ (line 1)
- Bill J9042 × 6 + JW (line 2 — waste)
- Reimbursement (Q2 2026): ~$38,697/dose
- 6-cycle A+CHP course: ~$232,180 (drug only)
ICD-10 by indication
| Code | For |
|---|
C81.x | Hodgkin lymphoma (cHL) |
C84.6x | ALCL ALK-positive |
C84.7x | ALCL ALK-negative |
C84.4x | PTCL NOS |
C84.0x | Mycosis fungoides (CTCL) |
C84.A | Primary cutaneous ALCL |
C84.1x | Sézary syndrome |
Z51.11 | Encounter for chemo (admin line) |
CD30 IHC required for CTCL/PTCL. CPT 88341/88342 same encounter or prior result.
ADC class comparison
| ADC | HCPCS | Target | Payload |
|---|
| Adcetris | J9042 | CD30 | MMAE |
| Polivy | J9309 | CD79b | MMAE |
| Padcev | J9177 | Nectin-4 | MMAE |
| Tivdak | J9273 | Tissue factor | MMAE |
| Enhertu | J9358 | HER2 | Deruxtecan (DXd) |
| Trodelvy | J9317 | Trop-2 | Govitecan (SN-38) |
Original FDA-approved ADC (2011 accel, 2017 full). MMAE class effect: peripheral neuropathy.
Payer requirements (May 2026)
| Payer | PA | Documentation focus |
|---|
| UnitedHealthcare | Yes | Stage III/IV for ECHELON-1; CD30 IHC for CTCL/PTCL |
| Aetna | Yes | NCCN-aligned; CD30 IHC for CTCL |
| BCBS plans | Yes | NCCN-aligned; CD30 IHC for CTCL/PTCL |
| Medicare LCDs | Varies | Label indications + NCCN compendium |
NCCN Cat 1 (preferred) for most labeled regimens (A+AVD, A+CHP, R/R cHL/sALCL).
Medicare reimbursement (Q2 2026)
| Field | Value |
|---|
| ASP + 6% | $268.727 / mg (eff 4/1 – 6/30/2026) |
| 96 mg dose (1.2 mg/kg, 80 kg) | $25,797.79 |
| 144 mg dose (1.8 mg/kg, 80 kg) | $38,696.69 |
| A+AVD 12-cycle course | ~$309,573 (drug only) |
| A+CHP 6-cycle course | ~$232,180 (drug only) |
| Mono R/R cHL max 16 cycles | ~$619,148 (drug only) |
Patient assistance — Pfizer Oncology Together
- Phone: 1-877-744-5675 (Pfizer Oncology Together)
- Adcetris Co-Pay Card: commercial $0 first dose
- Pfizer Patient Assistance Foundation: free drug for uninsured/underinsured
- Foundations (Medicare): PAF, HealthWell, CancerCare, LLS — verify open lymphoma funds quarterly
- Web: adcetris.com / pfizeroncologytogether.com
Peripheral neuropathy ~67% (dose-limiting MMAE class effect). Document neuro exam every cycle. G3 hold + reduce dose; G4 permanently discontinue.