Ocrevus (ocrelizumab) — HCPCS J2350

CareCost Estimate · Billing Cheat Sheet
Genentech, Inc. Single-dose 300 mg / 10 mL vial IV infusion every 6 months Reviewed: May 2, 2026 ASP: Q2 2026
HCPCS
J2350
1 mg = 1 unit
Maintenance
600 units
600 mg q6mo · 2 vials
Modifier
JZ
Required, every claim
Admin CPT
96413/96365
Chemo or therapeutic
Medicare ASP+6%
$59.596
/mg · $35,757.60/dose

Codes & NDC

HCPCSJ2350 — "Injection, ocrelizumab, 1 mg" (permanent, eff. 1/1/2018)
NDC50242-150-01 (10) / 50242-0150-01 (11) — N4 qualifier
Vial300 mg / 10 mL single-dose, 30 mg/mL
RouteIV infusion, dilute in 250 mL 0.9% NaCl
BenefitMedical (provider buy-and-bill); not specialty pharmacy

Dose schedule (FDA label)

  • Initial: 300 mg IV × 2 infusions, 14 days apart (bill 300 units each)
  • Maintenance: 600 mg IV every 6 months (bill 600 units; 2 × 300 mg vials)

Year-1 unit math (new patient)

Day 0 — 300 mg infusion: 300 units
Day 14 — 300 mg infusion: 300 units
Month 6 — 600 mg maintenance: 600 units
Month 12 — 600 mg maintenance: 600 units
Total year 1: 1,800 units

Administration codes

CodeWhen
96413Chemo IV, 1st hr (Genentech-recommended)
96415Chemo IV, each addl hr
96365Therapeutic IV, 1st hr (payer fallback)
96366Therapeutic IV, each addl hr
S9329 + 99601/99602Home infusion
Payer fork: default 96413/96415; flip to 96365/96366 for payers that don't recognize ocrelizumab as chemo-eligible.

Modifiers

ModWhen
JZRequired every claim (single-dose vial, no waste)
JWDoes NOT apply — no drug discarded
25On E/M when separately identifiable from infusion
JG / TB340B — per MAC policy
Common denial: Using JW instead of JZ. Resubmit with JZ.

ICD-10-CM (eff. 10/1/2025)

CodeFor
G35.ARRMS
G35.B0PPMS, unspecified
G35.B1Active PPMS
G35.B2Non-active PPMS
G35.C0SPMS, unspecified
G35.C1Active SPMS (covered)
G35.DMS, unspecified
Avoid parent code G35 — many payers reject.

Payer requirements (May 2026)

PayerPAStepRe-auth
UnitedHealthcare (2026D0056P)YesNo12 mo
Aetna (CPB 0264)YesNow/ response
Horizon BCBS-NJ (Policy 150)YesNo6 mo
No commercial step therapy. Site-of-care steering (off hospital outpatient) is the dominant UM lever at UHC and Aetna.

Medicare reimbursement (Q2 2026)

FieldValue
ASP + 6%$59.596 / mg (effective 4/1 – 6/30/2026)
600 mg dose$35,757.60 (600 units × $59.596)
After ~2% sequestration~$35,043 (actual paid)
NCD/LCDNone drug-specific; LCD L33394 (generic drug coverage)

Site of care

SettingPOSForm
Physician office11CMS-1500 / 837P
Ambulatory infusion suite49CMS-1500 / 837P
Hospital outpatient19/22UB-04 / 837I
Patient home12CMS-1500 / 837P

Patient assistance

  • OCREVUS Co-pay Program — commercial only
  • Genentech Patient Foundation — uninsured/underinsured
  • Patient Navigator: 1-844-OCREVUS / 1-844-627-3887 (M–F 9–8 ET)
  • Spoilage: 1-800-551-2231
  • Enroll: genentech-access.com
Different drug, different code: Ocrevus Zunovo (SC) = J2351, NDC 50242-554-01, 920 units, admin 96401. Confirm formulation before billing.
Sources: Genentech v6.0 (9/25), FDA label (8/25), CMS ASP Q2 2026, UHC/Aetna/Horizon policies, FDA NDC Directory. carecostestimate.com/drugs/ocrevus