Avastin family (bevacizumab) — J9035, Q5107, Q5118, Q5126, Q5129, Q5145

Six bevacizumab products — the disambiguation table CMS HCPCS + FDA verified May 2026

Reference Avastin and five IV biosimilars. All share one unit basis (10 mg), identical 100 mg/400 mg vial sizes, and the same FDA boxed warning, but each has its own HCPCS code, NDCs, manufacturer, and ASP.

All six products carry the same FDA boxed warning (GI perforation, surgery/wound-healing complications, hemorrhage). Pre-treatment surgical-history review and wound-healing assessment are standard of care for any bevacizumab product. Discontinue at least 28 days before elective surgery and do not restart for at least 28 days post-surgery or until the wound is fully healed.

Note: Aybintio (bevacizumab-vikg, Samsung Bioepis) and Onbevzi are approved in EU/other markets but are not on the U.S. market as of May 2026. The six codes above are the complete commercial-stage U.S. bevacizumab roster.

Dosing per indication FDA labels + NCCN 2025–2026

Every bevacizumab indication uses mg/kg (weight-based) dosing. Partial-vial waste is the rule. Initial infusion 90 minutes; second 60 minutes if first tolerated; subsequent 30 minutes.

Infusion timing

Initial infusion is administered over 90 minutes. If the first infusion is tolerated without significant infusion reaction, the second infusion may be given over 60 minutes. If the 60-minute infusion is also tolerated, all subsequent infusions may be given over 30 minutes. This is the standard taper across all six bevacizumab products and determines the 96413/96415 unit count per encounter.

Off-label intravitreal bevacizumab — 503B disambiguation Critical billing distinction

Off-label intravitreal Avastin for wet AMD, DME, and RVO is widely used in retina practice — but the billing path is fundamentally different from the oncology J9035 vial.

How off-label intravitreal works

Retina practices source intravitreal bevacizumab from a 503B outsourcing facility (FDA-registered compounder). The 503B repackages a 100 mg vial into individual unit-dose syringes, typically 1.25 mg / 0.05 mL. The syringe is shipped to the practice ready for intravitreal injection — no in-office compounding. This is the standard pathway for off-label retinal use of bevacizumab and avoids the risk of in-office vial fractioning.

Billing the 503B syringe

Per-injection compounded bevacizumab pricing is typically in the $50–$100 range across major 503B suppliers, compared to ~$2,974 for a 5 mg/kg J9035 oncology dose. The intravitreal cost gap vs. on-label intravitreal anti-VEGFs (Eylea, Lucentis, Vabysmo) is the primary clinical and economic driver behind off-label bevacizumab use in retina.

Bevacizumab is not FDA-approved for any ophthalmic indication. The CATT and IVAN trials established comparable efficacy to ranibizumab for wet AMD, leading to widespread off-label use. Documentation of informed consent for off-label use and compounded product is essential.

NDC reference — all six products FDA NDC Directory verified May 2026

Pad to 11 digits with a leading zero in the middle segment for CMS-1500 Box 24A.

Avastin (J9035) — Genentech labeler 50242

Mvasi (Q5107) — Amgen labeler 55513

Zirabev (Q5118) — Pfizer labeler 0069

Alymsys (Q5126) — Amneal labeler 70121

Vegzelma (Q5129) — Celltrion labeler 72606

Avzivi (Q5145) — Sandoz labeler 61314

Administration codes CPT verified May 2026

Bevacizumab is HCPCS chemo-classified for IV administration. 96413 + 96415 is the standard pairing across all payers for on-label oncology indications.

Infusion-time billing per dose

• Initial dose (90 min): 96413 × 1 + 96415 × 1 (the second hour is billed even though it’s only 30 min into hour 2 — per CPT, additional hour is billed when infusion exceeds the initial hour by > 30 minutes)
• Second dose (60 min): 96413 × 1 (no add-on; falls within the initial hour)
• Subsequent doses (30 min): 96413 × 1 (single hour code only)

Premedications & concurrent chemo

Bevacizumab is most commonly given in combination with cytotoxic chemotherapy (FOLFOX, FOLFIRI, carboplatin/paclitaxel, etc.) or with atezolizumab in HCC. Concurrent chemo agents are billed with their own admin codes (96413 for the initial chemo, 96417 for sequential chemo on the same date). Avastin is typically administered first (the longest infusion at initial dose), then chemo follows. Premedications for the concurrent chemo (antiemetics, dexamethasone) are billed under their own admin codes.

Modifiers — JZ, JW, and the weight-based waste calculation CMS verified May 2026

JW applies on essentially every bevacizumab claim where the calculated mg/kg dose does not land cleanly on a vial boundary. Worked example below.

JZ — required when no drug discarded

Effective July 1, 2023, CMS requires the JZ modifier on all single-dose container claims when no drug is discarded. For bevacizumab, JZ applies on the rare occasions when the calculated dose matches an integer combination of 100 mg + 400 mg vials (e.g., 5 mg/kg × 80 kg = 400 mg = exactly one 400 mg vial). Append JZ to the J9035 / Q5107 / Q5118 / Q5126 / Q5129 / Q5145 line.

JW — required for documented waste of unused single-dose-vial drug

For weight-based dosing at 5 / 7.5 / 10 / 15 mg/kg, the calculated dose almost never matches an integer combination of 100 mg + 400 mg vials, so partial-vial waste is the norm. CMS requires the JW modifier on a separate claim line for the discarded units (rounded per CMS rules), with the wastage documented in the medical record. Bill administered units (with JZ) and discarded units (with JW) on two separate lines, same date of service.

Apply each MAC’s rounding convention. Some MACs require billing the total drawn from the vial as administered units and reporting waste only when an entire additional vial would otherwise be required. Refer to your local MAC billing article for the exact rounding rule.

Modifier-line note

Both lines use the same HCPCS code (J9035 in this example) and the same date of service. The administered line carries JZ; the waste line carries JW. Some payers also expect drug-administration codes (96413/96415) to appear on the encounter once, paired with the administered line by date.

JG / TB — 340B drug pricing

Hospitals that purchase bevacizumab through 340B and bill Medicare report the JG modifier (acute-care hospitals) or TB modifier (rural sole community / critical-access hospitals), per CMS guidance. Most infusion suites do not use 340B pricing; only the hospital-outpatient setting does.

Modifier 25 — same-day E/M

Append modifier 25 to the same-day E/M code if a significant, separately identifiable evaluation occurred (clinical reassessment for next-cycle decision, surgical-clearance check, treatment-decision encounter, etc.). Routine pre-infusion check-in is bundled.

ICD-10-CM diagnosis codes FY2026 verified May 2026

Use the most specific code supported by chart documentation. Each indication has a distinct code family.

Site of care & place of service Verified May 2026

First IV dose typically office or AIC due to 90-minute infusion + observation; subsequent 30-minute doses fit cleanly in any infusion setting.

Payer site-of-care steering

UnitedHealthcare, Aetna, Cigna, and most BCBS plans apply site-of-care UM to specialty infusion drugs. For bevacizumab, payers typically prefer office (POS 11) or in-network AIC (POS 49) where facility fees are lower. Hospital-outpatient (POS 19/22) requires medical-necessity justification under most commercial UM policies. Bevacizumab’s subsequent-dose 30-minute infusion fits non-hospital sites cleanly.

Claim form field mapping Genentech / Amgen / Pfizer billing PDFs

CMS-1500 / 837P (physician office, AIC; POS 11/49) example for a 750 mg mCRC dose of J9035.

Source: Genentech Avastin Billing & Coding Brochure; Amgen Mvasi Billing Resource; Pfizer Zirabev Billing Guide; Amneal Alymsys, Celltrion Vegzelma, and Sandoz Avzivi billing resources.

Payer policy snapshot — biosimilar preference 2026 Reviewed May 2026

National payers have moved decisively to biosimilar-first or biosimilar-only policies for bevacizumab in 2026. Reference Avastin denials are common at UHC absent documented medical necessity.

Private-label biosimilars (Cordavis / Quallent)

Two PBM-affiliated private labels distribute private-label bevacizumab biosimilars through their affiliated specialty pharmacy and health-system contracts:

• CVS Cordavis — private-label distribution agreement covering Sandoz biosimilars (including Avzivi-derived bevacizumab supply in some contracts). Distributed through CVS Specialty channels for CVS Caremark (Aetna) clients.
• ESI Quallent — Express Scripts / Cigna private-label distributor offering bevacizumab biosimilar product through Accredo specialty pharmacy and contracted oncology practices.

Private-label products carry the same HCPCS code (Q-code) and ASP as the underlying biosimilar but flow through a different distribution channel. For the biller, the HCPCS does not change; for the practice manager, the buy-and-bill economics may differ. Verify which HCPCS the patient’s plan steers through and source accordingly.

2026 trend across national payers

Bevacizumab biosimilar market share continues to grow through 2026 as preferred-product designations and step-therapy mandates take effect. Per AJMC, biosimilar share of new bevacizumab starts has reached the majority of new starts and continues to climb under UnitedHealthcare commercial’s mandatory biosimilar policy.

What to document for medical-necessity approval (J9035 originator)

• Brand of biosimilar tried (Mvasi, Zirabev, Alymsys, Vegzelma, or Avzivi), HCPCS code, dates of administration
• Documented intolerance, infusion-reaction, or inadequate response (with objective measures: imaging response, lab values, performance status)
• Any clinical contraindication to the biosimilar pathway (rare; biosimilars share the same molecular structure)
• Treating oncologist’s clinical-justification letter

Medicare reimbursement CMS Q2 2026 (live)

Quarterly ASP from CMS Part B Drug Pricing File. All six bevacizumab codes refresh together each quarter (Q5145 may lag until first ASP submission cycle complete).

Cross-product price comparison (Q2 2026 ASP+6%)

Coverage

No NCD specific to bevacizumab as a class. Each MAC publishes a billing & coding article covering bevacizumab and biosimilars with covered ICD-10 ranges per indication. All MACs cover J9035, Q5107, Q5118, Q5126, Q5129, and Q5145 for FDA-approved on-label indications. Bill with the indication-specific ICD-10 (see ICD-10 by indication).

Canonical code source: CMS HCPCS quarterly update file.

Patient assistance — one program per manufacturer Manufacturer sites verified May 2026

• Avastin (J9035) — Genentech Access Solutions: phone 1-866-422-2377. Genentech Oncology Co-pay Program for eligible commercially-insured patients (annual maximum varies by indication). Genentech Patient Foundation for free drug to qualifying uninsured/underinsured patients. Independent foundations (PAN, HealthWell) for Medicare patients — verify open funds quarterly.
• Mvasi (Q5107) — Amgen Assist 360: phone 1-888-427-7478. Copay support for eligible commercially-insured patients; Amgen Safety Net Foundation for free drug to qualifying uninsured patients.
• Zirabev (Q5118) — Pfizer Oncology Together: phone 1-877-744-5675. Copay assistance and Pfizer Patient Assistance Program (PAP) for free drug to qualifying uninsured patients.
• Alymsys (Q5126) — Amneal Patient Support: phone 1-833-243-5400. Patient access services and bridge supply for benefit verification delays.
• Vegzelma (Q5129) — Celltrion Connect: phone 1-866-466-4046. Coverage support, copay assistance for eligible commercially-insured patients, and Celltrion PAP for uninsured/underinsured patients.
• Avzivi (Q5145) — Sandoz One Source: phone 1-844-726-3691. Sandoz One Source provides benefit verification, prior auth support, copay assistance, and Sandoz PAP for free drug to qualifying uninsured/underinsured patients.

Common denials & how to fix them

Frequently asked questions

What are the HCPCS codes for bevacizumab?

There are six bevacizumab HCPCS codes: J9035 (Avastin reference), Q5107 (Mvasi — bevacizumab-awwb, Amgen), Q5118 (Zirabev — bevacizumab-bvzr, Pfizer), Q5126 (Alymsys — bevacizumab-maly, Amneal), Q5129 (Vegzelma — bevacizumab-adcd, Celltrion), and Q5145 (Avzivi — bevacizumab-tnjn, Sandoz). All six share the same billing unit basis: 1 unit = 10 mg.

How many units do I bill for a bevacizumab dose?

All six bevacizumab codes use 1 unit = 10 mg, NOT 1 mg. Examples: an 80 kg mCRC patient at 5 mg/kg = 400 mg = 40 units; the same patient at 10 mg/kg (mCRC second-line / GBM) = 800 mg = 80 units; an 80 kg NSCLC patient at 15 mg/kg = 1,200 mg = 120 units. Convert mg to units by dividing by 10.

Does the JW modifier apply more often to bevacizumab than to fixed-dose drugs?

Yes. Every approved bevacizumab indication uses mg/kg (weight-based) dosing — partial-vial waste is the rule, not the exception. Vials are 100 mg (4 mL) and 400 mg (16 mL); calculated doses almost never match an integer combination. Bill JZ for administered units AND JW for the discarded units on a separate line. Document the waste in the medical record per CMS guidance effective 7/1/2023.

What is the FDA boxed warning for bevacizumab?

All six bevacizumab products carry the same FDA boxed warning with three components: (1) gastrointestinal perforation (incidence up to 3.2% across studies, can be fatal); (2) surgery and wound-healing complications (discontinue at least 28 days before elective surgery; do not initiate within 28 days post-surgery or until wound fully healed); (3) hemorrhage — including severe and fatal hemoptysis, GI bleeding, CNS bleeding, and vaginal bleeding. Pre-treatment surgical-history review and wound-healing assessment are standard of care.

Why does the biller need to distinguish reference Avastin from biosimilars?

Each bevacizumab product has its own HCPCS code, NDC, and ASP. Billing reference Avastin (J9035) when the patient received Mvasi (Q5107) is a denial trigger and a compliance issue. UnitedHealthcare requires use of a preferred biosimilar — J9035 will deny without documented medical-necessity justification. Aetna, Cigna, and most BCBS plans prefer the lowest-cost product on their formulary. Private-label biosimilars distributed through CVS Cordavis (Mvasi-derived) and ESI Quallent may be steered separately.

Is intravitreal Avastin (off-label, AMD/DME) billed under J9035?

No. Off-label intravitreal bevacizumab for wet AMD, DME, or retinal vein occlusion uses a 503B-compounded repackaged product — NOT a stock 100/400 mg vial. The compounded syringe is typically billed under J3590 (unclassified biological) or a J7999 / C9399 unclassified code per payer, and reimbursed at a per-injection fee far below J9035 oncology dosing. The intravitreal injection itself uses CPT 67028. Do NOT bill J9035 with H35.32xx (wet AMD) — this is a misuse-of-product flag and triggers post-payment recoupment.

What administration codes are used for bevacizumab?

For all six IV bevacizumab products: 96413 (chemo IV infusion, initial hour) plus 96415 (each additional hour) for all on-label oncology indications. Initial infusion is 90 minutes; second infusion is 60 minutes if the first was tolerated; subsequent infusions are 30 minutes. Bevacizumab is HCPCS chemo-classified, so 96413/96415 (not 96365/96366) is the correct admin pairing across all payers for on-label use.

What is the Q2 2026 Medicare reimbursement for J9035 Avastin?

Q2 2026 ASP + 6% for J9035 (reference Avastin) is approximately $74.355 per 10 mg unit. A typical 5 mg/kg mCRC dose for an 80 kg patient = 400 mg = 40 units × $74.355 = $2,974.20 before sequestration. Biosimilars are substantially cheaper: Q5107 Mvasi ~$23.735/unit, Q5118 Zirabev ~$25.854/unit, Q5129 Vegzelma ~$34.654/unit, Q5126 Alymsys ~$51.589/unit. Q5145 Avzivi ASP is pending publication in Q2 2026. ASP refreshes quarterly — see the live snapshot above.

Are bevacizumab biosimilars interchangeable with Avastin?

Mvasi (Q5107), Zirabev (Q5118), Alymsys (Q5126), Vegzelma (Q5129), and Avzivi (Q5145) are FDA-approved biosimilars to Avastin, but as of May 2026 none are designated “interchangeable” under FDA standards — pharmacy/infusion-center substitution is not automatic. However, payers can and do require biosimilar use through formulary and step-therapy rules. Bevacizumab biosimilars together hold the majority of new starts in 2025–2026 (AJMC); UnitedHealthcare commercial enforces biosimilar-only with denial of J9035 absent justification.

Source documents

1. AAPC — HCPCS J9035 (Avastin)
   Code descriptor and crosswalk reference
2. AAPC — HCPCS Q5107 (Mvasi / bevacizumab-awwb)
   Biosimilar code descriptor (Amgen)
3. AAPC — HCPCS Q5118 (Zirabev / bevacizumab-bvzr)
   Biosimilar code descriptor (Pfizer)
4. AAPC — HCPCS Q5126 (Alymsys / bevacizumab-maly)
   Biosimilar code descriptor (Amneal)
5. AAPC — HCPCS Q5129 (Vegzelma / bevacizumab-adcd)
   Biosimilar code descriptor (Celltrion)
6. AAPC — HCPCS Q5145 (Avzivi / bevacizumab-tnjn)
   Biosimilar code descriptor (Sandoz)
7. FDA Avastin label (BLA 125085)
   Reference bevacizumab prescribing information; boxed warnings; indication panel; dosing
8. Genentech — Avastin Billing & Coding Brochure
   CMS-1500 field guidance for J9035 across indications
9. Amgen — Mvasi billing resource (Q5107)
   Bevacizumab-awwb billing reference
10. Pfizer Zirabev medical information & billing guide
    Q5118 biosimilar dosing and admin reference
11. Amneal — Alymsys (Q5126) prescribing & billing
    Bevacizumab-maly biosimilar reference
12. Celltrion — Vegzelma (Q5129) product page
    Bevacizumab-adcd biosimilar reference
13. Sandoz — Avzivi (Q5145) product page
    Bevacizumab-tnjn biosimilar reference
14. NCCN Clinical Practice Guidelines — Colon Cancer
    mCRC bevacizumab regimens and dosing
15. NCCN Clinical Practice Guidelines — NSCLC
    Nonsquamous NSCLC bevacizumab dosing and combinations
16. NCCN Clinical Practice Guidelines — CNS Cancers (Glioma)
    Recurrent GBM bevacizumab dosing
17. NCCN Clinical Practice Guidelines — Cervical Cancer
    Persistent/recurrent/metastatic cervical bevacizumab dosing
18. NCCN Clinical Practice Guidelines — Ovarian Cancer
    Ovarian / fallopian / peritoneal bevacizumab regimens
19. NCCN Clinical Practice Guidelines — Hepatobiliary Cancers
    HCC atezolizumab + bevacizumab (IMbrave150 regimen)
20. UnitedHealthcare — Bevacizumab Commercial Medical Drug policy
    2026 biosimilar-mandatory designation; PA criteria for J9035 originator
21. AJMC — Q1 2025 biosimilar market share data (bevacizumab)
    Bevacizumab biosimilar market-share trajectory
22. CMS — Medicare Part B Drug ASP Pricing File
    Q2 2026 quarterly file (J9035, Q5107, Q5118, Q5126, Q5129, Q5145)
23. CMS — HCPCS quarterly update file
    Canonical HCPCS code source for bevacizumab family
24. CMS — JW / JZ modifier guidance
    Single-dose-container waste reporting (effective 7/1/2023)

About this page

We maintain this page as a living reference for the entire bevacizumab family. Medicare ASP pricing for all six HCPCS codes (J9035, Q5107, Q5118, Q5126, Q5129, Q5145) 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 manufacturer guide, FDA label, or major payer policy changes.

Found an error? Email hello@carecostestimate.com.

Refresh cadence

Reviewer

Change log

• May 2, 2026 — Initial publication of the six-product bevacizumab family reference. ASP data: Q2 2026 (J9035, Q5107, Q5118, Q5126, Q5129; Q5145 ASP pending). Payer policies: UnitedHealthcare commercial biosimilar-mandatory, UHC MA Part B step therapy, Aetna and Cigna lowest-cost biosimilar steering, BCBS plan-by-plan. AJMC Q1 2025 biosimilar market share cited.

Methodology

Every claim on this page is sourced inline. Pricing reflects the current CMS Part B Drug ASP Pricing File for all six bevacizumab codes. Payer policies are read directly from each payer’s published medical policy documents. We do not paraphrase from billing-software vendor blogs. The off-label intravitreal section explicitly disambiguates the 503B-compounded ophthalmic pathway from on-label oncology J9035 billing — this is the single most common compliance flag in real-world bevacizumab denial review.