Ocrevus (ocrelizumab) — J2350

Ocrevus and the ocrelizumab family

Ocrevus (ocrelizumab) bills under J2350, 1 mg per billing unit, from Genentech. It is a CD20-directed cytolytic antibody given by intravenous infusion for relapsing and primary progressive multiple sclerosis. No biosimilar exists for ocrelizumab.

Genentech also markets ocrelizumab as a subcutaneous product, Ocrevus Zunovo (ocrelizumab and hyaluronidase-ocsq, J2351), at a 920 mg dose billed with 96401 or 96372 instead of the infusion codes on this page. See the Ocrevus Zunovo reference → for its dosing and billing; its coverage policies share the same ocrelizumab corpus as this page.

Vials and NDC

One vial size covers every dose. The 600 mg maintenance dose is two vials (600 units), each 300 mg initial infusion is one vial (300 units), and the pediatric 150 mg initial dose (25 kg to under 35 kg) is half a vial — 150 units administered and 150 units on a JW line, the only discard scenario on this page.

The ocrelizumab family and MS infusion alternatives

Ocrevus Zunovo prices at $47.287 per mg against Ocrevus's $60.689, but its 920 mg subcutaneous dose allows $43,504.04 — more per dose than the 600 mg infusion, since the fixed dose is larger. Briumvi runs $71.09 per mg, Tysabri $23.93 per mg, and Lemtrada $2,506.20 per mg; all four bill and cover separately from Ocrevus, and a payer's site-of-care and step-therapy rules (see Coverage & access) often name several of them together.

This reference does not recommend one MS infusion product over another. The payer's own policy, not a clinical preference, decides which product a given patient can start on.

Ocrevus dosing

Every indication follows the same schedule: two 300 mg infusions two weeks apart, then 600 mg every 6 months. Pediatric patients 10 years and older weighing 25 kg to under 35 kg take half doses throughout; at 35 kg or more they take the adult schedule.

The maintenance infusion runs 3.5 hours or longer by default (Option 1); the label allows a 2-hour infusion (Option 2) once a patient has completed a prior Ocrevus infusion without a serious infusion reaction. Both initial 300 mg infusions run 2.5 hours or longer.

Infusion duration and administration codes

The 3.5-hour maintenance infusion (Option 1) is billed 96413 for the first hour plus 96415 twice for the remaining hours. The 2-hour maintenance option (Option 2) and each 2.5-hour initial infusion are billed 96413 plus 96415 once. See the full code table in Billing reference below.

Screen for active infection before every infusion, and delay dosing until it resolves. If a planned infusion is missed, give it as soon as possible rather than waiting for the next scheduled dose, and reset the schedule to the next dose 6 months from the dose that was given late; doses must be at least 5 months apart.

Pre-treatment and pre-medication

• Hepatitis B virus screening (HBsAg and anti-HBc) before the first dose; active HBV infection is a contraindication.
• Baseline serum quantitative immunoglobulins, aminotransferases, alkaline phosphatase and bilirubin.
• Live or live-attenuated vaccines at least 4 weeks, and non-live vaccines at least 2 weeks, before the first dose.
• Before every infusion: methylprednisolone 100 mg IV (2 mg/kg if under 40 kg) about 30 minutes prior, and an antihistamine 30 to 60 minutes prior; an antipyretic may be added. Observe the patient for at least one hour after the infusion completes.

Pediatric dosing

Patients 10 years of age and older weighing 25 kg to under 35 kg take half the adult dose throughout: 150 mg on day 1, 150 mg two weeks later, then 300 mg every 6 months. Each 150 mg dose draws 150 units from a 300 mg vial, leaving 150 units to discard on a JW line — the only waste scenario on this page. At 35 kg or more, pediatric patients follow the adult 300/300/600 mg schedule with no discard.

Need the units for a patient's dose? Convert dose to J2350 billing units →

Ocrevus billing reference

HCPCS

J2350 bills 1 mg per unit. A 300 mg infusion is 300 units, and the 600 mg maintenance dose is 600 units.

NDC

One package size, one NDC. See the vial table in Drug & products above. The 11-digit claim-form NDC is 50242-150-01, and it does not change across the initial or maintenance dose, since every step draws from the same 300 mg vial.

Administration

Two codes cover every infusion: 96413 for the first hour, plus 96415 for each additional hour. CPT 96413–96415 carries the complete code definitions.

Modifiers

JZ: required when no drug is discarded. JW: required for documented waste.

The 600 mg maintenance dose and each 300 mg initial infusion draw whole 300 mg vials, so JZ applies. The pediatric 150 mg initial dose is the exception: it draws half a vial, so 150 units are administered and 150 units are billed on a JW line. The billing-units calculator works through the vial math dose by dose: open the calculator.

Full unit, vial and modifier math for any dose: calculate Ocrevus billing units →

Claim form

CMS-1500 / 837P field map for a separately payable J2350 claim.

Ocrevus coverage

The Clearance corpus carries 27 payers and 251 rules for ocrelizumab. 23 of the 27 require prior authorization, and 8 require documented failure or intolerance of another agent first.

• 24 of 27 commercial payer policy sets require prior authorization; 3 do not say clearly, so confirm those on the call
• 0 name a preferred ocrelizumab product
• 8 of 27 payers require a generic disease-modifying therapy first: Anthem, BCBS Kansas, BCBS Mississippi, BCBS South Carolina, BCBS Tennessee, Centene, Excellus and Regence.
• 11 rules set site-of-care requirements, the live fight for an infused MS biologic.
• 6 rules set a quantity limit, most writing in the 600 mg every 6 months maintenance cap, and 4 require reauthorization on a 12-month calendar.

Prior authorization and the generic-DMT-first requirement

BCBS Mississippi requires the patient to have “tried and failed (see definition of Medication Failure in Policy Guidelines section) ONE of the following generic agents” — failure of one generic disease-modifying therapy: dimethyl fumarate, fingolimod, glatiramer or teriflunomide — or to show “signs or symptoms of highly active disease with documentation of at least ONE of the following: Spinal cord involvement.” Regence requires treatment with at least one low-cost DMT that was ineffective, not tolerated or contraindicated.

Excellus sets a general bar of “serious side effects or drug failure of at least two medications (oral or self-injectable) indicated for the treatment of multiple sclerosis (minimum 12-week trials),” but its first-line severe-disease pathway requires only “an adequate trial (minimum 12 weeks) of Kesimpta or clinical justification of why it cannot be used.” BCBS Kansas and BCBS South Carolina both require “a trial and failure of preferred therapy (if applicable).”

BCBS Tennessee requires step therapy outright, and Anthem requires “a trial and inadequate response (including but not limited to clinical relapse, new or enlarged lesions on MRI or confirmed disability progression) or intolerance…” to a prior agent. Centene requires documented failure of dimethyl fumarate, teriflunomide, fingolimod, and an interferon-beta agent or glatiramer for adults, unless contraindicated, before ocrelizumab.

Site of care: the central fight

Eleven of the 251 rules govern where Ocrevus can be infused. Aetna's policy is explicit: “Site of Care Utilization Management Policy applies for Briumvi, Lemtrada, Ocrevus, Ocrevus Zunovo, Tyruko, and Tysabri.” Blue Shield of California names a “preferred site of service, including the home, a physician's office, or an independent infusion center,” and HMHS restricts coverage to a “physician's office not affiliated with a hospital, specialized infusion centers not affiliated with a hospital or in the home.”

BCBS Florida adds requirements “if ocrelizumab (Ocrevus, Ocrevus Zunovo) is administered in a hospital-affiliated outpatient setting.” BCBS Arkansas points to a “separate policy on Site of Care or Site of Service Review (policy #2018030) for pharmacologic/biologic medications,” and Regence's rule for both MS indications reads “site of care administration requirements are met [refer to Medication Policy Manual, Site of Care Review, dru408].” BCBS South Carolina, BCBS HCSC, BCBS Kansas and Cigna also list Ocrevus within a site-restricted drug set.

PPMS is its own policy set

Ocrevus is the only anti-CD20 antibody labeled for primary progressive MS, and the Clearance corpus treats it as a separate dxKey — primary_progressive_multiple_sclerosis — carried by all 27 payers alongside the relapsing-MS dxKey. Dosing, quantity-limit and reauthorization language reads the same across both sets; a claim for primary progressive MS must still match the PPMS-specific policy rather than the relapsing one.

Quantity limits and reauthorization

BCBS Kansas caps “subsequent doses: single 600 mg intravenous infusion every 6 months” for both MS indications, Wellmark writes “maintenance: 600 mg every 6 months,” and Capital Blue limits the initial dose to “300 billable units (300 mg) on day 1 and day 15.” Reauthorization runs on a 12-month calendar: BCBS Mississippi's “length of approval: 12 months,” Capital Blue's validity “renewed every 12 months thereafter,” and BCBS Tennessee's 12-month grant “for all members (including new members) who achieve or maintain a positive clinical response as evidenced by experiencing disease stabilit…”

Pediatric coverage

Centene requires documented failure of fingolimod (Gilenya), unless contraindicated or clinically significant adverse effects occur, for patients age 10 to 17 — distinct from its adult requirement of failing three prior therapy classes. Excellus requires “serious side effects or drug failure to fingolimod” for pediatric relapsing-remitting MS.

ICD-10-CM by indication

Three indications, three codes.

Medicare

Medicare pays Ocrevus as a Part B physician-administered drug under J2350, at ASP plus 6% ($60.689 per mg in Q4 2026). The Medically Unlikely Edit for J2350 is 600 units per day, matching the 600 mg maintenance dose exactly.

Check the patient’s actual policy: See Ocrevus coverage by payer →

Ocrevus cost & financial access

Medicare ASP+6%: $60.689 / 1 mg · $36,413.40 / 600 mg. Administration (96413 plus 96415 × 2) allows $190.05 more, for a $36,603.45 Medicare-allowed total on the maintenance infusion; at 20% coinsurance with the $283 Part B deductible already met, the patient owes $7,320.69 ($7,282.68 drug, $26.65 for 96413 and $11.36 for 96415 × 2).

2 doses a year (600 mg IV every 6 months after the two 300 mg initial infusions) at $36,603.45 per infusion — drug plus 96413 administration — total $73,206.90 before the sequester. That is the full annual drug-plus-administration cost for a patient staying on schedule, before benefits or assistance.

Each 300 mg initial infusion allows $18,368.36 — $18,206.70 for the drug plus $161.66 for 96413 and 96415 × 1 — and the patient owes $3,673.67 at 20% coinsurance ($3,641.34 drug plus $26.65 and $5.68 administration), once the Part B deductible is met. The first year covers three infusions, 300, 300 and 600 mg, for $72,826.80 in drug cost alone.

Commercial plans pay a contracted rate that varies by payer and state; 37 of 37 payer price files in this site's data carry a J2350 rate. Aetna's all-states commercial median is $60.99 per unit, close to the $60.689 ASP+6% Medicare rate; at 600 units, that prices the maintenance dose at $36,594.00.

Patient cost

Patient responsibility = payer allowed rate − benefits adjustment − assistance. Confirm which infusion the encounter reflects before estimating: a 300 mg initial infusion prices differently from the 600 mg maintenance dose.

Calculate a Ocrevus patient estimate →

Copay & financial assistance

The OCREVUS Co-pay Program (drug co-pay + separate administration co-pay); same program for Ocrevus and Ocrevus Zunovo covers a commercially insured patient's drug cost at $0, up to $20,000 a calendar year, and covers administration separately — up to $1,500 in the first calendar year and $1,000 each year after. It excludes Medicaid, Medicare and any government plan.

Genentech Access Solutions ships Ocrevus free to an uninsured patient whose household income is under $75,000 for one person (the limit is higher for larger households), drug cost only; administration is billed separately. One PAN Foundation fund pays $8,000 a year - Multiple sclerosis (MS) - and two more list it, HealthWell Multiple Sclerosis Medicare Access and Good Days Multiple Sclerosis; check each fund's current status on the funds list.

See current Ocrevus assistance programs →

Common Ocrevus errors & fixes